Dhru Purohit Show: The Hidden Heart-Risk Marker 1 in 5 People Have

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You know what's concerning? Most people get their cholesterol checked regularly, but there's a critical heart risk marker that standard panels completely miss. And it can stay hidden for years.

You're talking about lipoprotein(a), right? Lp(a)?

I was just reading about Dhru Purohit's conversation with cardiologist Dr. Michael Twyman on this exact topic. It's fascinating because Dr. Twyman points out that everybody has Lp(a), but about 20% of the population has dangerously high levels. And here's the kicker—only about 1% of people actually know their number.

That's why recent guidelines now recommend everyone over 18 get tested at least once.

High Lp(a) is linked to coronary artery disease, stroke, and aortic stenosis.

Plus, it tends to run in families where heart disease shows up unusually early. So why has it been getting so much attention lately? Is it because of new treatment options? Well, that's the interesting part. Until recently, there was no strong way to lower it. The phase three results for pelacarsen really mattered because of this. The drug did lower Lp(a), but as Dr. Twyman explains, it failed to reduce major adverse cardiovascular endpoints. The marker moved, but outcomes didn't improve. That's a crucial distinction. It sounds like Dr. Twyman doesn't treat lipids as the whole story anyway, right?

Exactly. He says LDL and ApoB matter, but so do inflammation, metabolic health, sleep, and muscle fitness. He describes lipids as "shots on goal," while imaging shows whether plaque is actually forming. Here's something that surprised me—many people who have heart attacks actually have normal cholesterol. The real problem is often endothelial dysfunction and inflammation. That reframes everything. What about testing and interpretation? How should Lp(a) be measured? It should be measured once in life, preferably in nanomoles per liter. The relationship is close to linear—the more Lp(a) particles you have, the more atherogenic risk you carry. But here's what's tricky—inflammation can push the number higher. Things like high IL-6, illness, hypothyroidism, and even menopause can affect it. That's actually what happened with Dhru, wasn't it? He had a temporary spike during an inflamed phase. Right. Dr. Twyman says the key is investigating why inflammation is high, rather than obsessing over the Lp(a) number itself. He's especially concerned about the valve, warning that high Lp(a) is associated with a 300% higher likelihood of developing aortic stenosis. So what's the practical takeaway here? What should people actually do?

Dr. Twyman's message is clear: "It's not worth obsessing over lowering Lp(a). Instead, use it as a risk enhancer." He recommends focusing on sleep, circadian rhythm, protein, seafood, resistance training, and 90 days of consistent habits before adding supplements or medications. His core reminder? Heart disease is the leading cause of death, but you're empowered to take control.