Cut From Steel

HIS FATHER DIED AT 57. HE GOT CHECKED AT 52.

David Letterman knew heart trouble ran in his family. His father, Harry, survived a heart attack at just 36. A second attack killed him in 1973. Harry Letterman was 57 years old.

Plenty of men carry a story like that and decide it is fate. Letterman kept seeing his doctor instead. He did not wait for symptoms to make the decision for him. In January 2000, a routine checkup turned up a problem with his arteries. An angiogram found the blockages, and on January 14 surgeons gave him a quintuple bypass. He was 52.

Five weeks later he walked back onto the Late Show stage. He opened with a joke about having heart surgery and getting a haircut. Then he brought out the doctors and nurses who treated him and told the audience they had saved his life.

Letterman hosted the show for another fifteen years and signed off in May 2015. Since then he has made a long-running interview series for Netflix. His father's age, 57, is now more than twenty years behind him. In other words, the son did not repeat the father's story.

You cannot pick your parents. What you find out about them is up to you. Letterman found his trouble while there was still time to fix it, and that checkup bought him decades.

Your Last Checkup Came Back Normal. What Did That Actually Tell You?

▸ That everything is fine

▸ That nothing is wrong yet

▸ That the things they measured looked fine

▸ I am not sure

The third one is the honest answer, and it is a much smaller statement than it sounds.

A normal panel says nothing about the things that were not measured. And there is one test that checks what most panels completely miss — the one that is no longer part of a standard physical.

If you walked out of your last appointment reassured, this is worth ten minutes before the next one.

👉 See what most panels miss

THE NUMBER NOBODY RAN

You probably had a cholesterol test in the last year or two. The doctor scanned the page and said your numbers looked fine. You went home believing your heart was in decent shape for a man your age.

I want you to know what that page leaves out. A standard lipid panel measures LDL, HDL, triglycerides, and total cholesterol. It does not measure lipoprotein(a), which doctors shorten to Lp(a). In other words, one of the biggest inherited risks to your heart was never on the sheet.

You have probably been told that heart risk simply climbs with age. Age is part of it. For about 1 in 5 people, though, a big piece of the risk was handed down at birth.

IT'S NOT AGE. IT'S WHAT YOU INHERITED.

You can think of Lp(a) as a cousin of LDL with an extra sticky protein attached. Three facts make it worth your attention.

01 / It comes from your parents

Your Lp(a) level is set mostly by your genes. The European Atherosclerosis Society says more than 90 percent of it is decided by a single gene. Diet, exercise, and weight loss barely move it. That is why a lean, active man can still carry a high number.

02 / It reaches past the heart

Research links high Lp(a) to heart attack, stroke, and narrowing of the aortic valve. The damage can build for years without a single symptom. A family history of early heart disease is one of the clearest reasons to test.

03 / One test is usually enough

Because your genes set it, the number tends to stay about the same for life. The National Lipid Association said in 2024 that every adult should have it measured at least once. A simple blood draw does the job. Cleveland Clinic notes it is not part of a standard lipid panel, so you usually have to ask.

ASK FOR IT THIS MONTH

You do not need a new doctor or a fancy clinic. One sentence at your next visit will do it: “Can you add a lipoprotein(a) test to my blood work?” The American Heart Association says most insurance plans cover it.

You will get a number back in one of two units, nmol/L or mg/dL. The National Lipid Association treats 125 nmol/L, or about 50 mg/dL, and higher as high risk. Anything under 75 nmol/L is considered low.

You have not been handed a sentence if the number comes back high. No drug that targets Lp(a) has been approved yet. Your doctor may push harder on the risks you can change, like LDL, blood pressure, blood sugar, and smoking. Lowering those may cut your overall risk even when Lp(a) stays put.

I would also call your brothers and your grown kids. Lp(a) runs in families, so one result can warn three generations.

One last thing. You cannot change the genes you were given. What you do once you know them is your call.

— Travis

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