Testing
Lp(a) testing among US veterans rose ninefold from 2014 to 2023, but remains extremely rare and unevenly distributed (Am J Prev Cardiol 2024)
Original title: Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023
This retrospective cohort study used Veterans Affairs electronic health records to track Lp(a) testing among previously untested US veterans from January 2014 to December 2023. National testing rose from 1 test per 10,000 eligible veterans (558 tests) in 2014 to 9 per 10,000 (4,440 tests) in 2023, a nine-fold increase, while the proportion of elevated Lp(a) results (above 50 mg/dL) among those tested stayed stable over time. Veterans with a history of ASCVD, Asian race, and those living in neighbourhoods with lower social vulnerability were more likely to be tested. Despite the nine-fold rise, overall testing remains extremely low, and the stable elevated-result proportion supports expanding testing further. The authors flag that veterans in higher social-vulnerability neighbourhoods risk being left behind as testing expands and novel Lp(a)-targeted therapies approach the clinic.
Original abstract
Objective: Lipoprotein (a) [Lp(a)] is a causal, genetically-inherited risk amplifier for atherosclerotic cardiovascular disease (ASCVD). Practice guidelines increasingly recommend broad Lp(a) screening among various populations to optimize preventive care. Corresponding changes in testing rates and population-level detection of elevated Lp(a) in recent years has not been well described.
Methods: Using Veterans Affairs electronic health record data, we performed a retrospective cohort study evaluating temporal trends in Lp(a) testing and detection of elevated Lp(a) levels (defined as greater than 50 mg/dL) from January 1, 2014 to December 31, 2023 among United States Veterans without prior Lp(a) testing. Testing rates were stratified based on demographic and clinical factors to investigate possible drivers for and disparities in testing: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability.
Results: Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023, while the proportion of elevated Lp(a) levels remained stable. Factors associated with higher likelihood of Lp(a) testing over time were a history of ASCVD, Asian race, and residing in neighborhoods with less social vulnerability.
Conclusion: Despite a 9-fold increase in Lp(a) testing among US Veterans over the last decade, the overall testing rate remains extremely low. The steady proportion of Veterans with elevated Lp(a) over time supports the clinical utility of testing expansion. Efforts to increase testing, especially among Veterans living in neighborhoods with high social vulnerability, will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.