Rising Awareness of a “Triple Threat” Heart Risk in the US: Katherine Wilemon

Since 2012, the Family Heart Foundation has been tracking how often Americans are screened for lipoprotein(a) [Lp(a)], a genetically inherited form of cholesterol that significantly increases cardiovascular risk. Despite growing scientific interest, screening rates have historically been strikingly low: only hundreds or thousands of people per year in a country of hundreds of millions, according to Katherine Wilemon, CEO of the Family Heart Foundation.

A turning point emerged in 2019 with the launch of the HORIZON (NCT04023552) outcomes trial, which spurred greater clinical attention and a noticeable uptick in Lp(a) testing. That momentum stalled during the COVID-19 pandemic, when health care resources and patient visits shifted dramatically. However, in the years since, Lp(a) screening has begun to rebound and is now doubling roughly every 2 years. Even so, the absolute numbers remain alarmingly small—only about 1% of Americans have ever been screened for high Lp(a).

Communicating the danger posed by LP(a) is a challenge in itself. Wilemon describes Lp(a) as a “triple threat” to cardiovascular health: it causes blockages in the arteries; it is pro-inflammatory, worsening vascular damage; and it raises the risk of blood clots, which can trigger heart attacks and strokes.

Data from a Family Heart Foundation study, published in the European Heart Journal, underscore why this matters. Among people who already had atherosclerosis, elevated Lp(a) emerged as a continuous risk factor: the higher the Lp(a) level, the greater the chance of another cardiovascular event. The reported hazard ratio of 1.4 translates into a 40% increased risk of a subsequent event within just 5 years, a time frame patients can easily grasp.

Given that effective Lp(a)-lowering treatments are not yet widely available beyond labor-intensive apheresis (a blood-cleansing procedure), Wilemon emphasizes the importance of how risk is discussed. Using clear concepts like “triple threat” and relatable timelines, clinicians can convey seriousness without inciting paralyzing fear. Crucially, any conversation about risk should be coupled with actionable steps to reduce overall cardiovascular risk today—through lifestyle changes, optimizing other risk factors, and close clinical follow-up—while the medical community awaits targeted therapies for Lp(a).