You’ll have the story before: a person who’s been physically fit, not overweight, and never smoked, suddenly dies of a heart attack.  They may even have has their cholesterol checked and found it was normal.   

In a significant proportion of these cases, they’ve had an elevated blood fat called Lp(a) – “lipoprotein little a”. Lp(a) levels are determined by your genes, rather than lifestyle, so you only need one test to find out your level, as it remains relatively stable throughout life. 

There are two reasons why GPs tend not to test for Lp(a). One is that patients have to pay for it out-of-pocket – Medicare doesn’t cover it and it can cost around $70. The other reason is that there aren’t targeted medications yet which lower Lp(a), although low dose aspirin may have an effect. 

A recent study suggests that there are reasons for people to know their Lp(a) in addition to their other blood fats (eg. LDL and triglycerides), and therefore a strong case for the government to subsidise Lp(a) tests.   

It has to do with identifying your overall risk of a heart attack and stroke. If you discover you have a raised Lp(a), then you can make sure all your other risk factors – particularly blood pressure and LDL cholesterol, are as low as possible to minimise the additive impact of Lp(a). This knowledge allows for more proactive management of the risk factors you can control.   

This is worth a conversation between patients and their GPs, particularly when there’s a family history of early heart attacks or stroke.