Testing
Non-Hispanic Black and Hispanic patients are tested for Lp(a) far less often than white patients despite higher levels, in 56,833 US medical records (J Clin Lipidol 2024)
Original title: Race/ethnicity and socioeconomic status affect the assessment of lipoprotein(a) levels in clinical practice
In a single-centre retrospective study of 56,833 adults with a diagnosis of atherosclerotic cardiovascular disease, aortic valve stenosis, resistant hypercholesterolaemia, or family history of these conditions, only 4% (2,249 patients) had ever had an Lp(a) order. Non-Hispanic Black and Hispanic patients had markedly lower rates of Lp(a) testing (0.17% and 0.28%, respectively) than non-Hispanic White patients (2.35%, P<0.001), despite having higher median Lp(a) levels (P<0.001). Patients on Medicaid or from socioeconomically deprived areas were also less likely to be tested (incidence rate ratio 0.40 and 0.39 respectively, both P<0.001). The findings reveal race, ethnicity and socioeconomic disparities in Lp(a) testing that run counter to underlying risk.
Original abstract
Background And Objective: High lipoprotein(a) [Lp(a)] levels are a risk factor for atherosclerotic cardiovascular disease (ASCVD), however Lp(a) ordering in clinical practice is low. This study examines how race/ethnicity and socioeconomic status influence Lp(a) ordering.
Methods: This is a single center, retrospective study (2/1/2020-6/30/2023) using electronic medical records of adults with at least one personal ICD-10 diagnosis of ASCVD, aortic valve stenosis, resistant hypercholesterolemia (low-density lipoprotein cholesterol >160 mg/dL on statin therapy), and family history of ASCVD or high Lp(a). We evaluated Lp(a) level differences among racial/ethnic groups and sexes. We also assessed associations between diagnosis type, diagnosis number, age at diagnosis, race/ethnicity, socioeconomic score (based on zip codes), public health coverage and the presence of Lp(a) orders.
Results: 4% of our cohort (N=2,249 in 56,833) had an Lp(a) order (17.3% of whom identified as Hispanic, 8.7% non-Hispanic Black, 47.5% non-Hispanic White, and 27% Asian/other). Non-Hispanic Black and Hispanic patients had lower rates of Lp(a) orders (0.17% and 0.28%, respectively) when compared to non-Hispanic White patients (2.35%), p < 0.001, however, their median Lp(a) levels were higher, p < 0.001. Individuals on Medicaid or belonging to deprived socioeconomic groups were less likely to have an Lp(a) order (incidence rate ratio [IRR] = 0.40, p < 0.001 and IRR = 0.39, p < 0.001 respectively). Certain diagnosis (carotid stenosis, family history of ASCVD and familial hypercholesterolemia) and multiple diagnoses (>2) resulted in more Lp(a) orders compared to only one diagnosis (p < 0.001).
Conclusions: Lp(a) ordering is low in patients with or at risk for ASCVD. Non-Hispanic Black and Hispanic patients are less likely to have an Lp(a) order. Individuals on Medicaid and residing in socioeconomically deprived neighborhoods are less likely to have an Lp(a) order. Lp(a) orders depend on the type and number of patients' diagnoses.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.