The Overlooked Cholesterol Metric that Predicts Heart Health
Originally sent to subscribers on 15 June 2025
The Million Hour Memo
This week in the Million Hour Club, one of the members asked me if I could check her cholesterol levels. With a quarter of the world population being wiped out by heart disease each year (re‑read that), testing cholesterol—more specifically lipids—is a good idea... a very good idea. However, there's one metric that most people (including most doctors) miss when it comes to cholesterol—yet it's one that could dramatically change your long-term heart outcome: Lipoprotein(a) – Lp(a).
Let’s dive in...
DATA
Where insight becomes impact
What I’ve been looking at this week…
Most people haven’t heard of Lp(a). Even fewer have tested it. Here’s what's important:
It’s genetic: Lp(a) is a genetically inherited particle—you’re born with it, and it barely budges with lifestyle or statins. So you might wonder why test for it if you can't do anything about it? I'll come to that.
It’s potentially dangerous: It’s like LDL cholesterol with an extra component—apolipoprotein(a)—that makes it more likely to inflame arteries, promote blood clots, and accelerate plaque formation.
It’s invisible: It’s not included in standard cholesterol panels and most doctors still overlook it. Levels above 50 mg/dL or 125 nmol/L significantly increase cardiovascular risk. In fact, Lp(a) is now believed to be the most common genetic cause of premature heart disease.
I’ve tested my own level of Lp(a): 95 nmol/L. So what do I do with that number?
DEVICES
Track it to hack it.
What I’ve been monitoring this week…
Knowing my level means I can understand my personal risks. Using a specific risk calculator, I calculate not just where I stand now, but how my risk changes over time. This is me:
Without considering Lp(a) my lifetime risk of a heart attack or stroke by age 80 is 1.4%.
Including Lp(a): it rises to 1.7%.
That 0.3% increase may seem small. But in longevity terms, that’s the difference between risk and resilience, especially when you're building a Million Hour Life. That 0.3% might look like fine tuning, but it's a biological breadcrumb—a clue that signals a need to go deeper, earlier. Breadcrumbs always need cleaning up.
Here’s what I’ve learned: Knowing your number doesn’t mean panic. It means precision planning. Genetics alone don't determine your outcomes—your lifestyle decisions play a big part.
DECISIONS
From knowing to doing.
What this means for YOU…
If your Lp(a) is elevated, here’s what I recommend:
Reduce clotting risk:
Omega‑3s (2–4 g/day EPA and DHA).
Garlic (shown to reduce arterial stiffness and plaque progression).
Consider low‑dose aspirin under clinical supervision if personal risk justifies it.
Target inflammation at the source:
Niacin (2–3 g/day) can lower Lp(a) by up to 30% in some people, though it’s not for everyone.
Polyphenols: curcumin, quercetin, and resveratrol reduce inflammatory pathways associated with Lp(a).
An anti‑inflammatory diet with minimal ultra‑processed oils and sugars.
Prioritise your vascular health:
Zone 2 cardio to support endothelial function.
Oral health optimisation—poor gum health has been directly linked to increased Lp(a) risk.
Prioritise deep sleep and nervous system regulation (think HRV tracking and 6‑60 breathflow).
Plasma exchange is also emerging as a notable option. Looking ahead, Pelacarsen is a novel therapy currently in Phase 3 drug trials which may offer up to 80% reduction in Lp(a)—could be a future game changer if you have a very high genetic risk.
Case in point
One of my clients, a 48‑year‑old female entrepreneur running a chauffeuring business, had an active lifestyle and good cholesterol levels checked by her GP. I checked her Lp(a)—it was 172. She’d never heard of it before—and was stunned.
Here’s what we implemented:
Omega‑3 supplementation
More garlic in her anti‑inflammatory meals
Regular Zone 2 cardio
⏳ 10 weeks later:
Inflammatory markers dropped by 40%
VO₂ max improved by 11%
Insulin levels were down by 15%
Resting heart rate dropped to 60 bpm
Cardiovascular markers optimised. In her own words she said: “This test has changed how I think about prevention. I like being in the driving seat of my life!"
Even if you can't change your Lp(a) levels, heart health is multifactorial—optimise everything else.
If you'd like to make decisions with precision based on your personal data and using devices that are specific for you, then book a private consultation and let's start to decode your health.
DIARY
Where you’ll find me…
Last week:
It was my birthday week—I donated blood, met Bryan Johnson, popped over to Marbella as the only female speaker at a Men’s Health Retreat, then back to London to speak at Wellnergy about longevity and the menopause. Fabulous week, doing what I love and loving what I do!
This week:
Hosting the start‑up stage at the SME Expo in London. Speaking at Elevate—an amazing fitness expo in London. Celebrating National Women's Enterprise Week at The British Library. Speaking at Mindset Unlimited—a festival hosted by Alex Le Gioux in Wokingham.
Next week:
Being interviewed at The Groucho Club—which I am super excited about. And I have tickets for you! Groucho: If you'd like to come along to the beautiful Groucho Club in Soho, London on 17 June I have just 2 more select guest tickets available. SME Expo: If you're a business owner the SME Expo is for you. 18–19 June at Excel London. Elevate: If you're in the fitness or sports sector this has it all under one roof. Mindset Unlimited: 21 June in Wokingham—a festival of fun, food and focused activities. It would be lovely to see you so do come and say hello!
DISTINCTION
A thought to pause on…
“Not all cholesterol is created equal. And not all risks are visible.” Lp(a) is silent—but if you measure it early, you can take control with intelligence, not fear. You don’t need to panic, you need to plan.
So here’s my question for you this week: Have you ever had your Lp(a) tested? If not, what would it mean to you and your loved ones to intercept a heart attack before it makes its first move?
Wishing you a wonderful week ahead!
Dr Alka