Genetics
Amsterdam UMC review finds cascade screening for elevated Lp(a) needs as few as 1.3 relatives tested per new case found (Curr Opin Lipidol 2024)
Original title: Effectiveness of cascade screening for elevated lipoprotein(a), an underdiagnosed family disorder
This review synthesises recent evidence on the effectiveness of cascade screening, testing first-degree relatives of an index case, for identifying elevated Lp(a), a common genetic cardiovascular risk factor that current opportunistic screening detects poorly. Cascade screening was consistently found superior to opportunistic screening, identifying approximately one new case of Lp(a) at or above 125 nmol/L for every two first-degree relatives screened, with the number needed to screen ranging from 1.3 to 2.9 depending on the Lp(a) threshold and population studied. The authors identify remaining challenges for clinical implementation, including agreeing on threshold values to trigger cascade screening, accounting for ethnicity-related variability in Lp(a) levels, and further clarifying the strategy's real-world clinical relevance, as key steps toward optimising cascade screening protocols.
Original abstract
Purpose Of Review: Elevated lipoprotein(a) [Lp(a)] is a prevalent, independent, genetic risk factor for cardiovascular disease. Though crucial for adequate risk assessment, detection of individuals at increased risk because of elevated Lp(a) is severely lacking in practice. In this light, several consensus statements have recommended familial cascade screening strategies to increase detection of elevated Lp(a). This review aims to synthesize findings from recent research into the effectiveness of cascade screening for elevated Lp(a).
Recent Findings: Cascade screening is an effective method for identifying individuals with elevated Lp(a) and is superior to opportunistic screening. Cascade screening identifies approximately one new case of elevated Lp(a) ≥ 125 nmol/L for every two first-degree relatives screened. The number needed to screen (NNS) ranged from 1.3 to 2.9, depending on Lp(a) threshold values and selected population.
Summary: Cascade screening appears to be a promising strategy for identifying individuals with elevated Lp(a). However, several challenges persist regarding the implementation of this strategy in clinical practice. Deciding on threshold values for initiating cascade screening, considering the implications of ethnicity-related variability of Lp(a) levels, and further research into the clinical relevance of cascade screening are crucial steps. Understanding these factors will be essential for optimizing cascade screening protocols and enhancing its effectiveness in clinical practice.
cascade screeningDutch researchgenetics
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.