Darren Ali, a 52-year-old resident of Maple Ridge, British Columbia, suffered a heart attack at age 45 despite being otherwise healthy and having no prior symptoms.
He described the only warning sign as upper back pain three months before the event, which he later recognized as a precursor to a “widowmaker” heart attack.
Ali said he now believes an earlier blood test could have revealed his elevated levels of lipoprotein(a), or Lp(a), a genetically determined cholesterol-carrying particle that increases heart attack and stroke risk.
Research cited in the VanPeople article indicates approximately one in five Canadians — about eight million people — have high Lp(a) levels, putting them at greater risk for cardiovascular events.
Despite the prevalence, Lp(a) is not routinely screened because it typically presents no symptoms and is not included in standard cholesterol tests.
Updated guidelines from the Canadian Lp(a) Working Group, published this month in the Canadian Journal of Cardiology, recommend a one-time Lp(a) test for all Canadian adults to better identify high-risk individuals.
The guidelines, which align with similar recommendations from the American College of Cardiology released last month, emphasize that Lp(a) testing could significantly impact prevention of one of Canada’s leading causes of death.
Sonia Anand, professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, and a co-author of the guidelines, stated that among all detectable risk factors, Lp(a) testing holds substantial importance for preventing heart disease in Canadians.
Lp(a) consists of proteins and fats; elevated levels are dangerous because the particle is stickier than other cholesterol types and more likely to adhere to artery walls.
For more on this story, see ApoB Blood Test: Better Than “Bad Cholesterol” for Predicting Heart Disease.
Excess accumulation can form plaques that block blood flow to vital organs or rupture, triggering heart attacks or strokes, while also increasing clotting and inflammation risks.
According to the guidelines, Lp(a) levels at or above 100 nanomoles per liter indicate increased risk, and levels at or above 190 nanomoles per liter signify higher risk.
Anand noted that high Lp(a) may increase cardiovascular event risk by two to four times, though risk-reduction strategies are available.
What Lp(a) is and why it poses a hidden threat
Lipoprotein(a) is a cholesterol-carrying particle present in everyone’s bloodstream, composed of proteins and fats, with levels largely determined by genetics.
Because it is more adhesive than low-density lipoprotein (LDL), Lp(a) contributes to plaque buildup in arteries, which can restrict blood flow or rupture, leading to heart attacks, strokes, or aortic valve narrowing.
The particle also promotes inflammation and thrombosis, increasing the likelihood of plaque instability and cardiovascular events even in individuals without traditional risk factors.
How experts recommend addressing undiagnosed Lp(a) risk
The Canadian Lp(a) Working Group’s updated guidance urges family physicians to increase awareness and consider Lp(a) testing as part of preventive cardiovascular care.
It supports a one-time screening approach for all adults, arguing that identifying elevated levels allows for earlier intervention through lifestyle modifications and lipid-lowering therapies where appropriate.
Proponents say routine testing could prevent premature cardiovascular events in the estimated eight million Canadians unaware of their Lp(a) status.
What is lipoprotein(a) and how is it different from regular cholesterol?
Lipoprotein(a), or Lp(a), is a particle made of proteins and fats that carries cholesterol in the blood; it is stickier and more likely to cling to artery walls than other cholesterol types, increasing clot and plaque formation risk.
Who should get tested for Lp(a) and when?
Experts recommend a one-time Lp(a) blood test for all Canadian adults to identify those with elevated levels, regardless of age or apparent health, since the condition is genetic and often asymptomatic.