Testing
Just 0.42% of 700,580 Japanese ASCVD-prevention patients were tested for Lp(a), despite 7% of those tested exceeding the risk threshold, claims database study finds (J Atheroscler Thromb 2025)
Original title: Serum Lipoprotein(a) Levels and Their Association with Atherosclerotic Cardiovascular Disease in Japan
This study used the Medical Data Vision claims database to examine Japanese patients eligible for ASCVD prevention under 2017 Japan Atherosclerosis Society guidelines between July 2013 and June 2021, split into primary prevention high-risk, secondary prevention, and secondary prevention high-risk groups. Of 700,580 patients with documented LDL-C, only 2,967 (0.42%) were tested for Lp(a); among 2,170 eligible patients, median Lp(a) was 13.9 mg/dL, with 151 (7.0%) above the 50 mg/dL risk threshold. Lp(a) rose with risk category across all prevention groups, and the highest Lp(a) quintile carried markedly higher ASCVD event rates than the lowest (unstable angina 28.9% vs. 18.9%; myocardial infarction 18.7% vs. 10.1%; ischaemic stroke 27.9% vs. 17.0%). In the secondary prevention groups, achieving an LDL-C target below 70 mg/dL fell from 30.2% to 19.0% (Group II) and from 32.9% to 16.3% (Group III) moving from the lowest to highest Lp(a) quintile. The authors conclude Lp(a) testing remains very low in Japan despite a high prevalence of elevated Lp(a) among high-risk ASCVD patients.
Original abstract
Aims: To investigate the distribution of lipoprotein(a) (Lp(a)) and its association with atherosclerotic cardiovascular disease (ASCVD) in Japanese patients at high risk for ASCVD using a health insurance database.
Methods: Between July 2013 and June 2021, patients eligible for ASCVD prevention according to the 2017 Japan Atherosclerosis Society (JAS) guidelines with documented Lp(a) test results were extracted from the Medical Data Vision claims database and divided into three groups: primary prevention high-risk (Group I), secondary prevention (Group II) and secondary prevention high-risk (Group III). Data on lipid levels, cardiovascular morbidity risk factors and lipid-lowering treatments were extracted.
Results: Of 700,580 patients with documented low-density lipoprotein cholesterol (LDL-C), 2,967 (0.42%) were tested for Lp(a). In 2,170 eligible patients, the median [interquartile range] serum concentration of Lp(a) was 13.9 [7.5-24.6] mg/dL, with 151 patients (7.0%) above the recommended risk threshold of ≥ 50 mg/dL. Lp(a) levels increased with risk across all prevention groups. Being in the highest Lp(a) quintile (Q5) was associated with an increased frequency of ASCVD (28.9% versus 18.9% in the lowest quintile (Q1) for unstable angina; 18.7% versus 10.1% for myocardial infarction; 27.9% versus 17.0% for ischemic stroke). In the secondary prevention groups, the proportion of patients meeting an LDL-C target of ＜70 mg/dL decreased from 30.2% in Q1 to 19.0% in Q5 for Group II and from 32.9% to 16.3% for Group III.
Conclusions: Despite a high prevalence of Lp(a) ≥ 50mg/dL in Japanese patients at high risk for ASCVD, it found that the Lp(a) testing rate was very low.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.