Testing
Black and Hispanic ASCVD patients had Lp(a) tested at roughly a tenth the rate of White patients, despite higher median levels, in 56,833 records (medRxiv 2024)
Original title: Race/ethnicity and socioeconomic status affect the assessment of lipoprotein(a) levels in clinical practice
This single-centre retrospective study reviewed electronic medical records from February 2020 to June 2023 for adults with at least one ASCVD or resistant hyperlipidaemia diagnosis. Of 56,833 patients, only 4% had an Lp(a) order (17.3% of those tested were Hispanic, 8.7% non-Hispanic Black, 47.5% non-Hispanic White, and 27% Asian or other). Non-Hispanic Black and Hispanic patients had markedly lower Lp(a) ordering rates than non-Hispanic White patients (0.17% and 0.28% vs. 2.35%, p < 0.001), despite having higher median Lp(a) levels. Patients in deprived socioeconomic neighbourhoods or on Medicaid were also significantly less likely to have Lp(a) ordered (relative risk 0.39 and 0.40 respectively, both p < 0.001), while specific diagnoses such as carotid stenosis, family history of ASCVD, or familial hypercholesterolaemia, and having more than two diagnoses, increased the likelihood of testing. Lp(a) ordering in at-risk ASCVD patients is not only rare overall but systematically lower among Black, Hispanic, socioeconomically deprived, and Medicaid-covered patients, the very groups with higher measured Lp(a) levels.
Original abstract
Background And Objective: High Lp(a) levels are a risk factor for 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 ICD-10 diagnosis of ASCVD or resistant hyperlipidemia (LDL-C >160 mg/dL on statin therapy). 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, socioeconomic score (based on zip codes), public health coverage and presence of Lp(a) orders.
Results: 4% of our cohort (N=56,833) had an Lp(a) order (17.3% Hispanic, 8.7% non-Hispanic Black, 47.5% non-Hispanic White and, 27% Asian/others). Non-Hispanic Black and Hispanic patients had lower rates of Lp(a) orders (0.17%, 0.28%, respectively) when compared to non-Hispanic White patients (2.35%), p<0.001, however, their median Lp(a) levels were higher. Individuals belonging to deprived socioeconomic groups or on Medicaid, were less likely to have an Lp(a) order (RR=0.39, p<0.001 and RR=0.40, p<0.001 respectively). Certain diagnoses (carotid stenosis, family history of ASCVD and FH) and multiple diagnoses (>2) resulted in more Lp(a) orders compared to those with only one diagnosis (p<0.001).
Conclusions: Lp(a) ordering is low in patients with ASCVD. Non-Hispanic Black and Hispanic patients at risk are less likely to have an Lp(a) order. Individuals residing in socioeconomically deprived neighborhoods and on Medicaid are also less like have 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.