Testing
84% of high-Lp(a) patients in a lipid clinic were not on niacin despite meeting treatment criteria, a cohort of 692 patients (J Clin Lipidol 2012)
Original title: Lipoprotein (a): perspectives from a lipid-referral program
This study evaluated Lp(a) levels and niacin treatment eligibility in 692 patients (57% male, mean age 52 years) referred to a university lipid management program between January 2004 and June 2010, with mean Lp(a) of 32 mg/dL. African-American race, female sex, presence of coronary heart disease, and lower triglycerides independently predicted high-risk Lp(a) (at least 50 mg/dL). Among intermediate-risk patients by Framingham score, 9% had Lp(a) at least 50 mg/dL, versus 26% of high-risk patients, and 84% of these were not taking niacin; overall, 19% of moderate- and high-risk patients were eligible for niacin based on an Lp(a) cutoff of 50 mg/dL, with only 5.1% more added if a low HDL cholesterol cutoff of 40 mg/dL or below were also used. The findings show high-risk Lp(a) is associated with female sex, African-American race, and coronary heart disease, and that a substantial minority of at-risk patients qualify for niacin therapy under an Lp(a)-based indication.
Original abstract
Background: Lipoprotein (a) [Lp(a)] has a strong association with coronary disease (CHD). We evaluated the implications of implementing a niacin strategy in persons above low risk by the Framingham risk score (FRS).
Methods: Patients referred to a university lipid management program from January 2004 to June 2010 had an Lp(a) level measured at initial evaluation. Factors associated with an increase in Lp(a) and predictors of a high risk Lp(a) (≥50 mg/dL) were assessed. FRS and Lp(a) levels were used to assess eligibility for niacin with an Lp(a) ≥50 mg/dL.
Results: A total of 692 patients (57% male, mean age 52 ± 14 years) had a mean Lp(a) of 32 ± 40 mg/dL. In a multiple logistic regression model, African-American race, female gender, presence of CHD, and lower triglyceride levels were significant predictors of high risk Lp(a). Ten percent were determined to be intermediate and 44% high risk by FRS. A total of 9% of intermediate- and 26% of high-risk patients had an Lp(a) ≥50 mg/dL, and 84% were not taking niacin. A total of 19% of moderate- and high-risk patients were eligible for initiation of niacin based upon values ≥50 mg/dL. If niacin were also used for an high-density lipoprotein cholesterol levels ≤40 mg/dL, only 5.1% additional patients would require niacin.
Conclusion: High-risk levels of Lp(a) are associated with female gender, African- American race, and CHD. 19% of moderate and high risk patients would be candidates for treatment with niacin if the indication is a cutpoint Lp(a) ≥50 mg/dL.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.