Actor James Buckley revealed on his podcast that a blood test showed he has dangerously high levels of lipoprotein(a), a genetic cholesterol condition that doubles heart attack risk.
The Inbetweeners star made the disclosure on The Buckleys, which he hosts with his wife Clair. "I’m at a high risk now for a cardiovascular incident," Buckley said. "I’m not a religious man, but sometimes I feel like there is a God that sort of goes, 'That’ll teach you.'"
Buckley added: "There’s nothing you can do about it, by the way. And the doctor’s just been like, 'You need to change.'" Since his diagnosis, Buckley has overhauled his lifestyle, including cutting back on alcohol, although no medication currently exists to treat the condition directly.
Understanding lipoprotein(a)
Lipoprotein(a), or Lp(a), is a type of cholesterol particle made naturally by the liver. Scientists believe it helps repair damaged blood vessels and aid wound healing, meaning everyone has some in their bloodstream.
However, about one in five people inherit genes causing them to produce far higher Lp(a) levels than normal. Unlike low-density lipoprotein (LDL), the bad cholesterol largely influenced by diet, weight, exercise, smoking and alcohol, Lp(a) levels are almost entirely determined by genetics.
At high levels, Lp(a) behaves like LDL by sticking to artery walls, fueling inflammation and accelerating the build-up of fatty plaques that narrow blood vessels. It may also make blood more likely to clot, raising the risk of heart attacks and strokes.
Each Lp(a) particle carries an extra protein called apolipoprotein(a), or Apo(a), which makes it particularly effective at burrowing into artery walls. Because people are exposed to high Lp(a) from birth, vascular damage accumulates over decades, often leading to heart attacks and strokes before age 60.
Professor Kausik Ray, a cardiologist and professor of public health at Imperial College London, said: "It’s nastier because of that extra protein tail. If LDL is like taking 100 bullets to your arteries, Lp(a) is more like a bazooka - there’s much less of it around, but it does more damage."
Cardiologist Dr Ravi Assomull added: "Unlike other types of cholesterol, you can’t diet or exercise your way out of this. Some particles can stick to the artery walls and detach - this doesn’t. It invades the vessel wall, causes inflammation and then the formation of plaque which can potentially rupture, causing a clot to form and a heart attack."
Testing for lipoprotein(a)
Elevated Lp(a) causes no symptoms and is not detected by standard GP cholesterol checkups. For many individuals, the first sign of the condition is a heart attack or stroke early in life.
Regina Giblin, senior cardiac nurse at the British Heart Foundation, said: "Even if your cholesterol test comes back completely normal, you can still be living with elevated Lp(a)." She advised that anyone with a high incidence of early heart disease or heart attacks in relatives in their late 30s or early 40s should consider getting tested for inherited high cholesterol conditions.
A study published in 2009 showed that individuals with genetic variants causing high Lp(a) levels faced almost double the risk of cardiovascular disease. This evidence has driven calls to add Lp(a) screening to routine NHS Health Checks for over-40s in the UK.
Currently, the National Institute for Health and Care Excellence (NICE) does not recommend routine Lp(a) testing. A taskforce led by cholesterol charity Heart UK is urging increased recognition of Lp(a) and its addition to the QRISK tool used by doctors to calculate ten-year cardiovascular risk.
Testing requires a referral to a specialist lipid clinic or a private test. At-home private tests cost around £45, while private clinics charge between £65 and £130. A single blood test is sufficient because levels are largely fixed from birth.
Professor Ray said: "We’ve got a bit of work to do in terms of getting access to the test, and there’s even a postcode lottery when it comes to hospitals using it. That needs to change. I think everybody should be tested once in their lifetime."
Managing cardiovascular risk
High Lp(a) increases the risk of atherosclerosis, coronary heart disease, strokes, peripheral arterial disease, aortic valve disease and heart failure. Higher levels correlate with greater risk, with elevated rates more than doubling overall danger.
Professor Ray emphasized: "Don’t freak out if your number is high. There is nuance, based on other factors that also influence heart health, from whether you have high cholesterol, high blood pressure and type 2 diabetes, to whether you smoke and drink heavily, to your diet, your weight and whether you exercise."
Dr Assomull noted that ethnic background affects risk: "People with Afro Caribbean or South Asian heritage might have higher levels of Lp(a), while people from places like China and Japan may be less at risk."
Medical conditions such as chronic kidney disease, nephrotic kidney disease and hyperthyroidism can also raise Lp(a) levels. Levels may also rise during pregnancy or after menopause, though evidence remains limited on how or why this alters risk.
Current and future treatments
Statins do not lower Lp(a) and can slightly increase levels, but they reduce overall cardiovascular risk by lowering LDL cholesterol. Ms Giblin noted that some studies suggest statins may shrink Lp(a) particles, though clinical benefits remain unproven.
PCSK9 inhibitors such as Repatha and Praluent lower LDL and cut Lp(a) by about 25 percent, Dr Assomull explained. On the NHS, these drugs are reserved for patients whose LDL remains high despite statins or who cannot tolerate statins. Apheresis, a procedure filtering cholesterol from blood, carries risks like blood clots and is limited to the highest-risk patients.
New drugs specifically designed to lower Lp(a) are in late-stage clinical trials and could reach the NHS within five years. Lepodisiran, a twice-yearly injection blocking liver production of Lp(a), cut levels by up to 94 percent in trials, making it undetectable in some patients.
Pelacarsen reduces Lp(a) by around 80 percent in international trials, including in the UK, with results expected this year. Additionally, enlicitide (Lipfendra), approved last month by the FDA, cuts Lp(a) by about 28 percent, while obicetrapib, which could reach the UK by year-end, reduces Lp(a) by 40 to 50 percent.
Professor Ray said: "We’ve still got to show that lowering Lp(a) modifies outcomes. But the landscape could change considerably over the next few years. The next step is then gene-editing therapies."
Patient case study and lifestyle
While Lp(a) levels cannot be reduced through diet or exercise, experts say overall cardiovascular risk can be lowered substantially by managing controllable factors. Dr Assomull described Lp(a) as a "useful wake-up call."
Recommended actions include quitting smoking, limiting alcohol, controlling blood pressure and maintaining a healthy weight. Dietitians and nurses recommend a Mediterranean-style diet rich in fruit, vegetables, wholegrains, fish, nuts and seeds while reducing red meat and processed foods. The NHS recommends at least 150 minutes of moderate activity weekly, alongside regular resistance training.
Professor Ray said: "People often assume this is a death sentence. But no one single factor is going to predict that you’re going to have a problem, and there is a lot you can do to protect yourself."
At age 34, Prince Odu-Obi, a London Underground trains manager and father-of-one from Cuffley, Hertfordshire, suffered a heart attack in June last year despite being fit, eating well and never smoking. Rushed to Barts Hospital with chest and arm pain, doctors found his main coronary artery almost completely blocked.
Doctors told Odu-Obi he would have died had he delayed treatment. Private tests later revealed he inherited high Lp(a) levels. "I was completely shocked," said Odu-Obi, now 35. "Everything went blank when they said it was a heart attack. No one in my family has suffered heart problems and I was in great health."
Odu-Obi added: "Recovery was really difficult mentally. I went through a long phase of wondering if it was going to happen again, and struggling to look forward to life."
Following surgery to insert two stents, Odu-Obi takes a statin and ezetimibe, and expects to be eligible for upcoming Lp(a) treatments. He trains five times weekly, follows a Mediterranean diet with antioxidants, and drinks only water. "I understand how to reduce my risk now," he said. "But I wish I’d known about my elevated Lp(a) when I was younger. I’d have made sure I was even healthier, which might have prevented this from happening."
