Several risk factors for cardiovascular disease are well-known and commonly tested in routine checkups: blood pressure, cholesterol levels and body mass index, to name a few.

But up to one in five Americans has dangerous levels of the relatively unknown fatty acid lipoprotein(a) in their blood, according to The New York Times. Excessive lp(a) can accelerate formation of plaque in the arteries and promote blood clots.

“It’s sort of a double whammy,” Donald Lloyd-Jones, MD, a cardiologist at the Northwestern University Feinberg School of Medicine, told The Times. “Biologically, lp(a) both gets into the artery wall and causes damage there more easily.”

The newspaper told the story of Bob Harper, known for whipping contestants into shape on “The Biggest Loser.” This fitness trainer suffered a heart attack last February and was found to have high levels of the particle in his blood.

Another apparently healthy adult, 39-year-old Sandra Revill Tremulis, was considered to have a 1 percent risk of heart attack in her 40s based on the Framingham risk score. But when she became extremely fatigued during workouts she went to see a cardiologist, who found she had a 95 percent blockage in one of her coronary arteries. Like Harper, she had high lp(a), possibly inherited from her father, who died of a heart attack at age 50.

According to The Times, diet and exercise have little impact on lp(a), which can triple the risk of having a heart attack or stroke at an early age.

“People don’t know about it, physicians don’t know about it, and we have to get an education program out there, but that’s expensive,” said Henry N. Ginsberg, MD, a professor of medicine at Columbia University. “I would say that somewhere between 15 to 20 percent of the population would clearly benefit from knowing that this is their problem.”

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