Testing
Elevated Lp(a) is common in patients needing coronary intervention despite controlled risk factors, but screening does not change physician treatment decisions, a study of 113 patients (J Clin Lipidol 2017)
Original title: Lipoprotein(a) screening in patients with controlled traditional risk factors undergoing percutaneous coronary intervention
This study screened 113 patients presenting electively for percutaneous coronary intervention (PCI) for Lp(a), selecting those with premature coronary disease, family history of premature disease, well-controlled traditional risk factors, or at least moderate-intensity statin use despite still needing PCI. Lp(a) was elevated in nearly half of all subjects, including those with seemingly well-controlled lipids by prior guidelines, suggesting Lp(a) contributes to residual cardiovascular risk. However, knowledge of an elevated Lp(a) result did not significantly influence referring physicians treatment intensification for traditional modifiable risk factors (P=.18). The findings show elevated Lp(a) is highly prevalent, even at a young age, among high-risk patients presenting for PCI, but judicious screening alone did not change physician management, suggesting previously unappreciated residual risk remains unaddressed.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is an inherited atherogenic lipoprotein and an independent risk factor for atherosclerotic cardiovascular disease; however, its clinical role remains limited.
Objective: We hypothesized that Lp(a) screening in high cardiovascular risk patients could provide insight into disease pathogenesis and modify physician behavior for treatment intensification targeting traditional risk factors when Lp(a)-related risk was identified.
Methods: We screened 113 patients presenting electively for percutaneous coronary intervention (PCI) for Lp(a) who met any of the following criteria: (1) premature coronary artery disease (male age <55 years, female age <65 years); (2) family history of premature coronary artery disease; (3) progression to PCI despite well-controlled traditional risk factors (blood pressure <140/90 mm Hg, and low-density lipoprotein cholesterol <100 mg/dL, and HbA1c <7%, and nonsmoker); or (4) progression to PCI despite at least moderate intensity statin use (simvastatin 40, atorvastatin 40-80, or rosuvastatin 20-40 mg daily).
Results: In this high-risk cohort, Lp(a) was elevated in nearly half of all subjects, including those with seemingly well-controlled lipids by prior guidelines, suggesting a role for Lp(a) in conferring residual cardiovascular risk. In our cohort, when screened positive, knowledge of an elevated Lp(a) did not influence referring physicians' treatment intensification targeting traditional modifiable cardiovascular risk factors (P = .18).
Conclusion: When screened judiciously, elevated levels of Lp(a) are highly prevalent in high cardiovascular risk patients, including at a young age, presenting for PCI and may contribute to previously unappreciated residual cardiovascular risk.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.