Testing
Across 5 US health systems, just 0.4% of 595,684 ASCVD patients were tested for Lp(a), with older and Black patients tested least (J Am Heart Assoc 2024)
Original title: Lipoprotein (a) Testing in Patients With Atherosclerotic Cardiovascular Disease in 5 Large US Health Systems
This retrospective electronic-medical-record study across five large US health systems identified 595,684 patients with atherosclerotic cardiovascular disease (ASCVD) between 2019 and 2021, of whom only 2,587 (0.4%) were tested for Lp(a). Older patients and Black individuals were significantly less likely to be tested, while those with familial hypercholesterolaemia, ischaemic stroke or TIA, peripheral artery disease, prior lipid-lowering therapy, or LDL-C at or above 130 mg/dL were more likely to be tested. Patients who received an Lp(a) test, regardless of the result, were far more often started on any statin (30.3% vs. 10.6%), ezetimibe (7.65% vs. 0.8%), or a PCSK9 inhibitor (6.7% vs. 0.3%) than untested patients, and those with an elevated Lp(a) specifically were more often started on ezetimibe (11.5% vs. 5.9%) or a PCSK9 inhibitor (10.9% vs. 4.8%). Lp(a) testing in ASCVD patients remains rare and unevenly distributed by age and race, but testing itself, and especially an elevated result, is linked to more intensive lipid-lowering treatment.
Original abstract
Background: Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease. However, lipoprotein (a) testing remains variable and it is unclear what factors influence testing and if testing changes clinical management.
Methods And Results: A retrospective study using electronic medical record data from 5 health systems identified an atherosclerotic cardiovascular disease cohort divided into those with and without a lipoprotein (a) test between 2019 and 2021. Baseline characteristics and lipid-lowering therapy patterns were assessed. Multivariable regression modeling was used to determine factors associated with lipoprotein (a) testing. Among 595 684 patients with atherosclerotic cardiovascular disease, only 2587 (0.4%) were tested for lipoprotein (a). Those who were older or Black individuals were less likely to have lipoprotein (a) testing, while those with familial hypercholesterolemia, ischemic stroke/transient ischemic attack, peripheral artery disease, prior lipid-lowering therapy, or low-density lipoprotein cholesterol ≥130 mg/dL were more likely to be tested. Those with a lipoprotein (a) test, regardless of the lipoprotein (a) value, were more frequently initiated on any statin therapy (30.3% versus 10.6%, P < 0.001), ezetimibe (7.65% versus 0.8%, P < 0.001), or proprotein convertase substilisin/kexin type 9 inhibitor (6.7% versus 0.3%, P < 0.001) compared with those without a test. Those with an elevated lipoprotein (a) level more frequently initiated ezetimibe (11.5% versus 5.9%, P < 0.001) or proprotein convertase substilisin/kexin type 9 inhibitor (10.9% versus 4.8%, P < 0.001).
Conclusions: Lipoprotein (a) testing in patients with atherosclerotic cardiovascular disease is infrequent, with evidence of disparities among older or Black individuals. Testing for lipoprotein (a), regardless of level, is associated with greater initiation of any lipid-lowering therapy, while elevated lipoprotein (a) is associated with greater initiation of nonstatin lipid-lowering therapy. There is a critical need for multidisciplinary and inclusive approaches to raise awareness for lipoprotein (a) testing, and its implications on management.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.