Screening could detect hidden heart risk in 1 in 5 people

A study published this week in the journal *Nature Medicine* found that very high levels of a cholesterol‑related particle called lipoprotein(a), or Lp(a), double the risk of serious heart events, including stroke and heart‑related death, in a group of more than 20,000 adults. The research was led by scientists at the University of Toronto and the University of Cambridge and followed participants for an average of 12 years. The findings suggest that many people may be carrying a hidden heart‑risk factor that routine cholesterol tests miss.

Lp(a) is a small particle that carries cholesterol in the blood. Unlike the common LDL cholesterol, Lp(a) is largely determined by genetics and can remain high for life. Because most health check‑ups measure only total cholesterol, LDL, HDL and triglycerides, Lp(a) levels are rarely checked. High Lp(a) can promote plaque buildup and clot formation, making it a unique contributor to heart disease that standard tests do not reveal.

In the study, participants in the top 10 percent of Lp(a) levels—those above 50 mg/dL—experienced a 30 percent increase in stroke risk and a 25 percent rise in cardiovascular death compared with those in the lowest quartile. The researchers adjusted for age, sex, smoking, blood pressure and other risk factors, and the association remained strong. The investigators noted that current guidelines do not recommend routine Lp(a) testing, but the data point to a large group of people who could benefit from additional screening.

The next step is to integrate Lp(a) testing into standard cardiovascular risk assessments. Some clinicians already order the test for patients with a family history of early heart disease or unexplained high cholesterol. New drugs that lower Lp(a) are in late‑stage trials, and a positive test could become a trigger for aggressive treatment. For patients, a simple blood draw could uncover a silent risk and open the door to preventive care that might save lives.