Universal Lp(a) screening meets nearly every criterion except outcome-trial proof that lowering it helps, a review of detection strategies (Curr Opin Endocrinol Diabetes Obes 2023)

Original title: Detection strategies for elevated lipoprotein(a): will implementation let the genie out of the bottle?

Curr Opin Endocrinol Diabetes Obes · 5 December 2022 · 5

Loh WJ, Watts GF

This review by Loh and Watts examines strategies for detecting elevated Lp(a), an important causal risk factor for atherosclerotic cardiovascular disease, particularly coronary artery disease. Selective testing is recommended for patients at intermediate to high cardiovascular risk, and because Lp(a) is predominantly genetically determined, cascade testing of close relatives of probands with high Lp(a) has proven effective. Some recent guidelines go further, recommending Lp(a) measurement at least once in every adult lifetime, with various implementation strategies proposed. The authors conclude that hyper-Lp(a) meets nearly all criteria for universal screening, except that clinical interventional trials have not yet shown that lowering Lp(a) reduces cardiovascular events, and call for further evaluation of the cost-effectiveness of different detection and implementation strategies.

Original abstract

Purpose Of Review: Elevated Lp(a) level is an important causal risk factor for atherosclerotic cardiovascular disease (ASCVD), principally coronary artery disease. Selective testing for Lp(a) is highly recommended in patients at intermediate and high risk for ASCVD. Lp(a) levels are predominantly genetically determined, and this has implications for cascade testing.

Recent Findings: Recent studies show that cascade testing is effective in identifying elevated Lp(a) in close relatives of probands with high Lp(a). Apart from selective testing and cascade testing as detection strategies, some recent guidelines recommend testing of Lp(a) in all adults at least once in their lifetime and various implementation strategies have been suggested.

Summary: Hyper-Lp(a) is an important global health problem that can be easily detected. Hyper-Lp(a) meets all the criteria for universal screening except that there is not yet supportive evidence from clinical interventional trials showing a reduction of ASCVD events. The cost-effectiveness of the various detection and implementation strategies need to be further evaluated.

Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.