Darren Ali never imagined something so serious was building beneath the surface. At 45, the only hint that anything was wrong was a bit of upper back pain — nothing alarming enough to raise concern. Three months later, he suffered a massive heart attack. “It’s almost like an elastic band’s tightening inside your chest,” said Ali, now 52, who lives in Maple Ridge, B.C. If he had taken a simple blood test earlier, he might have discovered that he had high levels of Lipoprotein(a), or Lp(a) — a genetically determined particle that carries cholesterol in the blood. Knowing that could have revealed his elevated risk and possibly helped him take steps to prevent the heart attack.
Research shows that about one in five Canadians — nearly eight million people — have high levels of Lp(a), increasing their risk of heart attacks and strokes. Yet many remain unaware, largely because Lp(a) isn’t part of routine screening and doesn’t present clear symptoms, as reported by CBC.
That’s something experts are now pushing to change. A new set of guidelines from the Canadian Lp(a) Working Group, published this month in the Canadian Journal of Cardiology, aims to improve awareness among family doctors who may not be familiar with the condition. The recommendations outline the risks, possible treatments, and reinforce earlier advice that all Canadian adults should undergo a one-time screening to identify elevated Lp(a) levels — echoing similar guidance from the American College of Cardiology.
“When we consider all of the potential things to be measured, this is a very important one to prevent one of the most common causes of death amongst Canadians,” said Dr. Sonia Anand, a professor of medicine and epidemiology at McMaster University in Hamilton, Ont., and one of the authors of the updated guidance.
So, what exactly is Lp(a)?
Lipoprotein(a) is a combination of protein and fat that naturally circulates in everyone’s bloodstream. However, higher levels can be dangerous. Compared to other types of cholesterol, Lp(a) is stickier, making it easier for it to cling to the walls of blood vessels.
Over time, this buildup can form plaques that restrict blood flow to vital organs like the heart and brain. In severe cases, these plaques can rupture or block arteries entirely, leading to heart attacks or strokes. Lp(a) can also increase clotting and inflammation, further raising the risk.
“If it’s elevated, an individual may have a two- to four-fold increased risk of a cardiovascular event, and there are things we can do to lower the individual’s risk,” said Anand.
According to the updated guidelines, Lp(a) levels of 100 nanomoles per litre or higher are considered elevated, while levels of 190 nanomoles per litre or more signal a significantly higher risk, CBC reported. Managing Lp(a), however, isn’t straightforward.
Because levels are largely determined by genetics, they tend to stay stable throughout life and can’t be easily changed. There are some exceptions — levels may rise during pregnancy or after menopause — but for most people, they remain consistent.
That’s why family history matters. If someone in your immediate family has high Lp(a), it’s worth getting tested as well, says Dr. Alykhan Abdulla, a family physician in Manotick, Ont. He also points out that certain health conditions — including heart disease, stroke, dementia, kidney issues, obesity, fatty liver, and even erectile dysfunction — can prompt doctors to investigate further.
Some populations are also more at risk. Studies have found that people of African or Caribbean descent, as well as those with South Asian ancestry, are more likely to have elevated Lp(a) levels. Testing for Lp(a) requires a specific blood test, as it’s not included in standard cholesterol panels. Dr. Jodi Heshka, a cardiometabolic specialist at the Ottawa Heart Institute, believes it should become a routine part of screening.
“I would really encourage patients to ask about it, ask their health-care providers,” she said. When it comes to treatment, options are still limited. Lifestyle changes like improving diet or increasing exercise won’t lower Lp(a) levels, though they remain essential for overall heart health.
There are currently no medications specifically designed to reduce Lp(a), but research is ongoing. In the meantime, patients with high levels are often prescribed statins. While these drugs don’t lower Lp(a), they help reduce another harmful cholesterol — LDL — which can offset some of the risk.
Despite the lack of targeted treatments, doctors stress the importance of awareness. “Knowledge is power,” says Anand, emphasizing that early detection can help prevent serious events or at least make people more alert to warning signs. Ali, now part of a drug trial, hopes future treatments will make a difference — especially for the next generation.
“My youngest daughter actually has a lipoprotein(a) level higher than I did when I had my heart attack,” said Ali. “She’s actually already on statins and she’s only 25. … It just takes a simple blood test. This is something every Canadian really should be tested for.”
Media professional and journalist based in British Columbia, Canada. Founder of Studiox Film & TV Corporation, focusing on multicultural news, interviews, and community storytelling across Canada.
