The Current - This cholesterol test could save your life

Episode Date: May 7, 2026

Darren Ali was a healthy 45 year old when he had a massive heart attack that could have killed him. He wants everyone to learn from his experience and get tested for the cholesterol Lipoprotein(a) because it could save their lives. And we'll hear from a doctor about how this cholesterol can cause unexpected heart attacks among younger and otherwise healthy people -- and why new guidance recommends getting tested.

Look, you may have noticed that it wasn't just the outfits that people were talking about when it comes to this year's Met Gala, but the politics surrounding fashion's biggest event. I'm Alameh Mammu, and this week on my podcast commotion, we're talking about billionaire Jeff Bezos and his wife, Lauren Sanchez, co-chairing this year's Met Gala, which managed to upset activists and fashion insiders. Check out the conversation that I had with fashion critics about how billionaire involvement changed the Met Gala. You can find and follow commotion on YouTube or wherever you get your podcasts. This is a CBC podcast. Hello, I'm Matt Galloway, and this is the current podcast. At 45 years old, Darren Ali believed he was a healthy man. Didn't smoke, was young, happily married, life was good.

And then in 2019, the unthinkable happened. He had a massive heart attack that no one saw coming. And Darren Ali's experience is a warning to the approximately 8 million Canadians who have high levels of a type of cholesterol doctors call lipoprotein little A or LPA. Many people have no idea. They have this kind of high cholesterol because there is no routine screening for LPA. In a moment, we'll speak with one of the doctors involved in creating newly published guidance aimed at raising awareness around LPA. But first, we're

joined by Darren Ali. He is in Maple Ridge, British Columbia. Darren, good morning. Good morning to you, Matt. This story starts on a night that you and your wife happened to go on vacation to Vancouver, right? Yeah, we're taking a little local rendezvous downtown, staying down there for, you know, just dinner and an outing. The kids were back at the home base, just having a get-together with their friends. So we wanted a nice, quiet weekend away,

and it was, yeah, we got a lot more than we bargained for, I guess. It was not nice and it was not quiet. What happened? It wasn't. Actually, we just gone out, you know, there's a lot of irony in it. I went out, had a wonderful steak at one of the great restaurants in downtown on the waterfront. And we actually walked there from a hotel and walked back. And when I got to the hotel, I just, you know, I just didn't feel right.

I started to, I broke out into a sweat, which was very unusual for me. And then the way I describe it to most people is it's a very unique pain. It was almost like rubber bands pulling inside my chest and tightening right up. And it's a pain like unlike anything else that I knew immediately what it was. Even though I've never experienced it before, you just know. And I told my wife, call down, I'm going to need an ambulance. And yeah, I mean, that was kind of the. the beginning of the evening when the ambulance came to get me,

and thankfully I was very close to St. Paul's Hospital. You knew immediately that you were having a heart attack? I knew immediately. It's just a, it's not like a pain that you have when you scrape yourself or break something. It's a very, very unique pain, and I knew immediately. As I said in the introduction, you're a healthy guy, right? You didn't smoke.

You were young. Oh, yeah, just, you know, the occasional social drink and an event. And actually, it's interesting that thankfully I did live my life that way because the cardiologist, when I was admitted the next morning at St. Paul's, he told me that the heart attack that I had, I would have not have survived if I was a smoker or a drinker. They call it the widower. The widder maker for good reason. Yeah. How close were you? Very scary.

I would imagine how close were you to not making it? And did you know when you went into hospital that it was as serious as a name like that sounds? No, I had no idea. I knew what it was, but I honestly, I never felt that I was in dire danger at all, even through the whole experience. I just never had that feeling. I always felt like, okay, I'm just going to get looked after by doctors and I'll be just fine. And, yeah, there was actually some moments that were concerning when I was picked up by the paramedics in the ambulance. Like, she, the paramedic that treated me first, she said, she asked me where I was from.

And I was like, I'm from Maple Ridge and stuff like that. And she's like, you are so lucky right now because you are four minutes away from St. Paul's Hospital. How do you think about that? I want to ask more about the cause of this, but just how do you think about what you went through and the fact that had you been at home, for example, or not four minutes away, had you gone to a different restaurant,

I might not be talking to you. Yeah, I mean, it's something that it's hard to wrap your head around, but, you know, I think lots of people are faced with challenges in life. And, you know, when you get through something like this, you have to just look at life with a different perspective and embrace every day. I mean, what more can you do? I mean, I was four minutes away from not being here, so.

That's wild. You now know that the cause of what you went through, this heart attack, was high levels of something called lipoprotein little A, LPA. That's right. This cholesterol that's really hard to track, and we're going to talk more about that with a doctor. But did you have any sense that this was going on? I didn't know I was having anything that was related to,

a genetic disposition to heart disease at all. You know, unfortunately, up until that point, I'd never heard of this. It's kind of probably not too unique story, unfortunately, but I actually went into my GP at the time, and I had earlier that year, I had met some of my friends at a conference, and he had had a heart attack, And he was telling me that one of the indicators that he had felt was a pain in his,

behind his right shoulder. So it was interesting because I was showering and I kind of felt a weird feeling in the back of my right shoulder. And I thought back to, oh, man, you know, my buddy told me this was kind of a sign. So I mentioned it to my wife and she was right on the ball, go make an appointment with your GP. You never go see the doctor. Go see the doctor. So I went and saw my GP and my GP looked at me and then, you know, did the kind of basic tests and don't worry about it. You know, you're not young anymore.

You're, you know, you're going to be 45. It's likely just some growing pains and old age pains and, you know, what they typically say. So that was three months before my heart attack. And had you ever been tested for this type of cholesterol? No, no, no. No. And so now that you're on the other side of this, what are the, what are your doctors doing to keep your cholesterol in check and keep your heart healthy? Yeah. So I had really, really wonderful care at St. Paul's. I'll say that right off the bat, absolutely amazing hospital. I actually, he recommended that I totally changed my diet at the time. So I actually went vegan for over two years.

and my wife joined me. We both went vegan for over two years. And so that was quite something. No more steak for you. No more steak for me. You got all my levels in line. I still, actually, I still recommend, I don't eat any red meat anymore.

I'm only white meats and vegetables and stuff like that. But when I was at the hospital, it was so impactful because that night I was there, a 25-year-old athlete also came in with a heart attack. So that just goes to show that, you know, it's not really an age thing. And so at St. Paul's, they have a healthy heart clinic, and they approached me and said, hey, you know, we're going to be part of this trial, this drug trial for heart disease. So, you know, I didn't hesitate.

I enter that trial. I'm almost at the end of the trial, actually. The end is coming up right now. And, you know, that gives me a lot of hope. And Canadians should have a lot of hope because, you know, it's a simple blood test for life of protein A. And, you know, going forward now,

we're going to have a medication that is pretty powerful in preventing this. The other part of this is that, and you hinted at this, this is in many ways determined by genetics, right? What is that meant for your family? You have kids? I've got four kids.

Yeah, three girls and a boy. And, yeah, it's fascinating because my son has a very low level. So he makes a joke all the time. He's going to eat and have whatever he wants because he's good to go. And unfortunately, my girls are a little bit high level. And my youngest daughter, she actually has a higher level than when I had my heart attack. So they've already put her on statins,

and she's going to be 25 this year in October. That's going to be something that she's going to be on for the rest of her life, maybe, or at least until maybe new medication comes along. Yeah, I mean, I'm hopeful for the trials that I'm on right now when they actually become available. It's something that can really change her life and give her an incredible future. I think a lot of people, I'm going to let you go,

but I think a lot of people will hear this story and wonder, They know about other forms of cholesterol and so-called bad cholesterol, but they may have never heard of this. And so what would your advice be to us, but also to doctors across this country, about making sure that people are tested for this? Yeah, I mean, I think it's almost a non-question. We get blood tests throughout our life all the time for a million different reasons. This is just, you know, another screening on a blood test. I think physicians across the country should just be doing this. You know, you only really need to do it once.

So just to see what your genetic marker is. And I would hope that every Canadian would hear this and go get tested. There's nothing, there's no downside to getting tested. You're only going to know, you know, what your, how you should maybe approach your life if you have a high level. And it's better to know than to be in the dark, especially when it's such an easy thing to find out. And how are you doing now?

I'm doing great. I'm doing great. I have no complaints. And yeah, like I said, I'm still in the study and I'll continue that. And we'll keep monitoring my kids. And yeah, I'm happy to be here. And live like you went through something and you're lucky to be here in some ways, right? I'm very lucky to be here.

Yeah, you've got to just embrace life. You never know when that door is going to close. So you've got to spend that good quality time with your friends and family and loved ones. And remember that each day, you know, is a blessing. That's a good bit of advice. I'm glad to have the chance to talk to you. Glad you're here. Darren, thank you very much.

Thank you so much. Darren Ellie is in Maple Ridge, British Columbia. Okay, three songs. You guess who they're by. Three little birds, one love, and jamming. Yeah, that was a really hard quiz. These are all, of course, by Bob Marley. A whole lot of the world felt close to Bob and his music before and after his passing. But the guy who really knew him best was his son, Ziggy.

On cue, Ziggy Marley will tell you about his new record and about the song he says connect him to his late father, Bob Marley. You can hear that conversation now. Just search Q with Tom Power wherever you get your podcasts. Dr. Sanya Anand is a professor of medicine and epidemiology at McMaster University in Hamilton, Ontario, part of a Canadian Lipoprotein Little A working group in one of the authors of this updated guidance meant to raise awareness of the dangers of this cholesterol among family physicians. She's in Hamilton this morning.

Dr. Adnan, good morning to you. Good morning, Matt. What do you make of Darren's story? Is that unusual that somebody who seems to be totally healthy, has this lurking within them and that they could be, I mean, he says he's within four minutes of death. Had he not been close to that hospital because of the scale of the heart attack that he had? Unfortunately, Matt, it's not unusual, especially as a vascular specialist. I hear this type of story regularly, and we know that up to 50% of people who suffer a massive heart attack do not make it to hospital. alive. We know a lot about so-called bad cholesterol, LDL, right? What makes this cholesterol so

dangerous? Well, this is similar in some ways to LDL or bad cholesterol, but it's joined together with a certain protein called apolypropotene little A, which gives it its own unique and higher risk ability to promote what we call atherosclerosis, but it's that yellow. plaque that gets laid down inside arteries. And the additional feature is it's 90% genetically mediated. So you inherit this gene that then produces higher levels of LP little A. I'd heard it referenced as like the more dangerous cousin to LDL in some ways. That's correct. If you are one of these people, research shows that one in five Canadians have high levels of this form of cholesterol. How do you if you actually are one in five?

Well, you're right that 20% of Canadians will have this protein. That's one in five. And sometimes the first signal that you might be at risk is if you have a family history of a father, mother, brother, or sister who've had or suffered an earlier than expected heart attack. And earlier than expected is what? So typically we say for men below the age, of 55 and women below the age of 60 is consistent with a family history of early onset heart

disease. So that's the first clue sometimes that perhaps more biomarkers should be measured in certain people. But the best way to know and the only way to know is to have your blood test measured for lipoprotein little A. Beyond that, there are no symptoms that would be obvious. That's correct. Yeah. Is there, you mentioned the genetic component to this. Is there a cohort? Is there a demographic that is more likely to have high levels of this cholesterol? That's a great question because I mentioned the overall average in Canada would be 20%, but certainly there are individuals from specific ethnic and racial groups who may have higher levels. and in particular people of African or Caribbean origin, as well as people who originate from the Indian subcontinent, known as South Asians.

They typically will have a higher prevalence of elevated lipoprotein little A, more in the range of 25 to 30%. There are a lot of people, I think, who are having this conversation now because we're having this conversation. They may not know about it as patients. What about family physicians? Are they aware or as aware of?

this type of cholesterol compared to other more common forms? I think knowledge about lipoprotein little A is increasing. I've been in practice for 25 years. And 25 years ago, it was difficult to measure LP. Little A. Typically, we had to do it within a tertiary care hospital, but couldn't do it out in community labs. Part of the reason is that the lab measurement wasn't standardized. So a value in one center could be very different from a value in another center.

But now we have greater standardization across labs. And the lipoprotein little A measurement is covered by the government across Canada. So there is greater awareness amongst people as well amongst family physicians, but there is still a ways to go. I do have patients I see in my specialty clinic who ask, Why wasn't this measured by my family doctor? And I think there's a gap in translating the knowledge of the importance of lipoprotein little A that has not yet reached some family physician.

Are these tests particularly expensive or complicated? Part of this is just picking up on you're one of the authors of this guidance. And the guidance suggests routine screening. But as we even heard from Darren, and I think a lot of us would have the same experience, that testing is not something that people are familiar with in some ways. Yes, it used to be patients had to pay out of pocket, so that cost them about $60. Now they are not charged. But there is a discrepancy in the recommendations between different medical societies.

So the Canadian Cardiovascular Society has recommended since 2021 that lipoprotein little A be measured once in a person's lifetime. On the family medicine side, the Family Medicine Peer Guidance Committee did not, endorse measurement of routine lipoprotein little A. So that's part of the discrepancy amongst medical specialists. Your recommendation would be for people to ask for it then? Ask for that test? Yes, it would be. Once in a lifetime, because it's genetically mediated, is, I think, very reasonable for a relatively

low-cost biomarker that can predict with a high degree of certainty, whether or not, you're at risk for a heart attack, a stroke, peripheral artery disease that affects the limbs, abdominal aortic aneurysm, and also a valve in the heart called calcific aortic stinosis. People will know that if you have higher levels of other forms of cholesterol, you may be encouraged, and Darren was encouraged, to change your diet, change your lifestyle, perhaps go on something like a statin. If you find out that you have high levels of this cholesterol, what can you do about it? This cholesterol being genetically mediated is at the present time not lowered by all the healthy,

active living lifestyle approaches recommended to improve heart health. It also is not lowered by a cholesterol medication known as a statin, and therefore doing these things will not alter lipoprotein little A, but they will lower the global cardiovascular risk, of the individual. And having a high level of lipoprotein little A means you have an efficient transport mechanism of taking the LDL or bad cholesterol right to the arteries and laying it down as plaque. So if we can reduce what it's transporting the LDL, then there will be less plaque deposited. So that's one of the rationales to use a statin for patients who have elevated LP little A. But the good news is that there are now medications in clinical trials that seek to disrupt

the production of L.P. Little A in the liver. And if these trials are effective, they will be able to be used to help people like Darren who have suffered a heart attack and still have persistently high LP little A levels. Until that point, just finally, and you've hinted at this in terms of people asking for these tests, but what would you want people to be thinking about? Again, Darren, somebody who is young, healthy, and suddenly has, you know, what people call a widowmaker and could have ended up in a very precarious situation or worse. And so what should we be thinking about here? We should be thinking, as Darren said, knowledge is power. So if as an individual, you have this knowledge about lipoprotein little A, you should ask your family.

physician or specialist to measure it. And the second thing is an ounce of prevention is worth a pound of cure. So if we are aware of this lipoprotein level early enough, healthy active living strategies can be put in place plus or minus some other medical therapies. And we can prevent massive heart attacks in other cardiovascular complications. I think every healthy individual in Canada would want that opportunity if it exists. And now we have a way to measure lipoprotein little A on a wide scale with a great deal of accuracy. So I strongly endorse that it should be measured once in an individual's lifetime. Dr. Anand, good to speak with you about this. This is really important. Thank you very much. Thanks, Matt. Dr. Sonia Anand is a professor of medicine and

epidemiology at McMaster University in Hamilton, Ontario. You've been listening to the current podcast. My name is Matt Galloway. Thanks for listening. I'll talk to you soon. For more CBC podcasts, go to cbc.ca.ca slash podcasts.