Cut From Steel

He ran ten miles a day and never saw the number that mattered

Jim Fixx weighed 214 pounds and smoked two packs of cigarettes a day before he started running in his mid-thirties. He rebuilt himself from the ground up.

Fixx published The Complete Book of Running in 1977. It sold more than a million copies and held number one on the New York Times list for eleven weeks. He is a large part of the reason ordinary American men ever started running at all.

On 20 July 1984 Fixx had a heart attack while running on Route 15 near Hardwick, Vermont. He was 52 years old.

The autopsy is the part I want you to hold onto. One coronary artery was 95 percent blocked. The second was 85 percent, and the third was 70. Fixx also had a congenitally enlarged heart. His father Calvin had a heart attack at 35 and died of another one at 43.

I am not telling you this to talk you out of running, and Fixx very likely bought himself years with it. He simply never had the numbers that would have told him what he was running against.

Being fit is not the same as being informed. You can be the fittest man on your street and still be the one nobody ever tested properly.

Your cholesterol panel is missing a line

You had the panel done, and the number you remember is LDL. Your doctor said it looked fine, and you have not given it a thought since.

I want to tell you about a test that is genetic, that you only ever need once, and that almost certainly nobody has offered you. It is called lipoprotein(a), written Lp(a). Harvard Health reports that only 0.3 percent of people received Lp(a) screening between 2012 and 2019.

You cannot diet it away or run it off, which is precisely why it is worth knowing about.

It's not age. It's these three.

I will give you three things about your blood work that the word normal manages to cover up entirely.

01 / Lp(a) Is Written In

Harvard Health puts it flatly. Your genes determine your Lp(a) value, and eating and exercise habits have virtually no effect on the level in your bloodstream. High levels may double or even triple a person's risk of a heart attack, and the raised risk extends to stroke and to aortic stenosis as well.

02 / Once Is Enough, For Life

Lp(a) remains largely constant over a person's lifetime, so Harvard Health says a one-time test suffices for screening. The first official endorsement for testing in the United States only arrived in 2024, which is why a man your age has almost certainly never been offered it. One draw, one time, and the question is closed.

03 / No Pill Yet, And It Still Matters

No approved treatment lowers Lp(a) today. Several therapies are in development, with results expected within the next year or two. Knowing your number changes how hard you work on everything standing next to it... blood pressure, LDL, weight, tobacco. A man who knows he starts three lengths back runs a different race.

Take it back today

I owe you the honest state of play. Universal testing is still an argument inside cardiology rather than a settled rule, and reasonable doctors differ on what a man should do with a high result while no treatment exists for it.

You should also know that a high number is not a sentence. Plenty of men carry elevated Lp(a) and live long lives, and the whole point of finding out is to change the effort you put in everywhere else. Ask your doctor whether apolipoprotein B is worth adding for you too.

I want one phone call out of you today. Ask for lipoprotein(a) to be added the next time you have blood taken, and write the result somewhere you will still have it in ten years. Two minutes on the phone, one extra line on a form.

You have been carrying one letter of the alphabet around for twenty years and calling it your cholesterol. Ask for the line that only has to be drawn once. Do it before the weekend starts.

— Travis

Insider Member's Corner

6 free habits that count double when the genetics are stacked:

Friday is for the things you would actually write down on a list.

01 / Wheels · Alfa Romeo Giulia Quadrifoglio

A four-door saloon with a twin-turbo V6 making around 500 horsepower, rear-wheel drive, and an engine developed with heavy input from Ferrari engineering. It seats your family and it still frightens you on a slip road. Alfa reliability jokes have followed this car since launch, and buyers keep signing anyway. Drive one before you decide you are a sensible man.

02 / Blade · Benchmade Bugout

Just under two ounces in the pocket, a 3.24-inch blade, and Benchmade's AXIS lock, which opens and closes with one hand. It is made in Oregon and it disappears in a trouser pocket so completely that you forget it is there until the day you need it. A man should be able to open a box, cut a rope and take a splinter out. This does all three.

03 / Glass · The Manhattan

Two parts rye, one part sweet vermouth, two dashes of Angostura, stirred over ice for a proper thirty seconds and strained into a chilled glass with one good cherry. Shaking it is a mistake and everybody who does it knows. The Manhattan predates most of what you drink and outclasses all of it. Make one on a Friday and make only one.