Testing
ApoB and Lp(a) testing make up less than 1% of all US lipid panel testing, across four national claims databases (Am J Prev Cardiol 2024)
Original title: Low prevalence of testing for apolipoprotein B and lipoprotein (a) in the real world
This cross-sectional analysis used four US claims data sources (including Medicaid, Medicare, and commercial insurance) to estimate 2019 testing prevalence for any lipid panel component, apolipoprotein B (ApoB), and Lp(a), standardised to the US Current Population Survey. Over a third (38%) of insured US adults underwent testing for any lipid panel component in 2019, higher among those 65 and older than younger adults (62% vs. 31%). However, ApoB and Lp(a) testing together represented under 1% of all lipid-panel-related testing. A companion cohort analysis using Optum claims data from 2019 to 2021 found lipid testing overall increased with age and comorbidity burden. Despite guideline recommendations to test ApoB and Lp(a) alongside the standard lipid panel, uptake of these advanced markers remains negligible in real-world US practice, supporting calls for targeted education campaigns from guideline-issuing bodies.
Original abstract
Objective: Apolipoprotein B (ApoB) and lipoprotein (a) (Lp[a]) are predictors of cardiovascular disease (CVD) risk; therefore, current recommendations for CVD risk assessment and management advocate that patients receive testing for ApoB and Lp(a) in addition to the standard lipid panel. However, US guidelines around ApoB and Lp(a) testing have evolved over time and vary slightly by expert committee. The objective of this analysis was to estimate the number of insured individuals in the USA who received any component of a lipid test, or ApoB and/or Lp(a) testing, during 2019.
Methods: We conducted a cross-sectional analysis to estimate the prevalence of any component of a lipid test, ApoB, and/or Lp(a) in the USA using four different claim data sources (including Medicaid, Medicare, and commercially insured enrollees). Prevalence estimates were age-, sex-, payor-, and region-standardized to the 2019 US Annual Social and Economic Supplement of the Current Population Survey. We also described the clinical profile of patients who received lipid testing between 2019 and 2021 (cohort analysis) in Optum claims database. Enrollees were grouped into four non-mutually exclusive cohorts based on their completion of any component of the lipid panel, ApoB, Lp(a), or ApoB and Lp(a).
Results: In the prevalence cohort, over a third (38 %) of insured adults in the USA underwent testing for any component of a lipid panel in 2019. This proportion was higher for individuals aged ≥65 years compared to younger adults (62% vs 31 %). The proportion of ApoB and Lp(a) testing represented only <1 % of testing for any component of a lipid panel. In the cohort analysis, we found that lipid testing increased with age and comorbidities.
Conclusion: These data should be considered by guideline-issuing agencies and organizations to develop education campaigns encouraging more frequent use of tests beyond the standard lipid panel.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.