Epidemiology
Lp(a)HERITAGE US subanalysis finds only 14% of 7,679 ASCVD patients had ever been tested, despite median Lp(a) 2.5-fold higher in Black participants (J Clin Lipidol 2025)
Original title: Lipoprotein(a) levels in a population with clinical atherosclerotic cardiovascular disease in the United States: A subanalysis from the Lp(a)HERITAGE study
This descriptive subanalysis of the multicentre Lp(a)HERITAGE study (NCT03887520) examined Lp(a) in 7,679 US participants with established atherosclerotic cardiovascular disease (ASCVD) who had Lp(a) measured in nmol/L (80.5% White, 66.4% male, mean age 63.8 years). Only 14% of all US participants had an Lp(a) measurement before enrolling in the study, despite already having ASCVD. Median Lp(a) was more than 2.5-fold higher in Black participants (132.0 nmol/L) than in the overall population (52.1 nmol/L), and higher in females (69.4 nmol/L) than males (45.6 nmol/L). Lp(a) at or above 125 nmol/L, the threshold for high ASCVD risk, was present in 52.0% of Black and 38.9% of female participants, versus 33.3% overall. The findings highlight both markedly under-utilised Lp(a) testing in US ASCVD patients and a disproportionately high burden of elevated Lp(a) in Black and female patients specifically.
Original abstract
Background: Elevated lipoprotein(a) (Lp[a]) is the most common inherited dyslipidemia that is independently and causally associated with increased atherosclerotic cardiovascular disease (ASCVD) risk. However, data from diverse populations with ASCVD are lacking.
Objective: To evaluate Lp(a) levels in a diverse, contemporary United States (US) population with ASCVD, stratified by race, ethnicity, and sex.
Methods: Lp(a)HERITAGE (NCT03887520) was a multicenter study that estimated the prevalence of elevated Lp(a) in adults (18-80 years) with ASCVD. US participants with Lp(a) measured in nmol/L pre- or post-enrollment were included in this subanalysis. This study was descriptive; therefore, no statistical comparisons were made.
Results: Of all US participants, 14% had an Lp(a) measurement pre-enrollment. This subanalysis included 7679 US participants with Lp(a) measurements in nmol/L (80.5% White; 66.4% male; mean age 63.8 years [standard deviation ± 9.7]). Median Lp(a) was > 2.5-fold higher in Black participants (132.0 nmol/L; IQR, 57.1-239.6) vs the overall population (52.1 nmol/L; IQR, 15.7-167.8), and higher in females compared with males (69.4 nmol/L; IQR, 20.1-194.7 vs 45.6 nmol/L; IQR, 14.0-152.6, respectively). Lp(a) levels ≥ 125 nmol/L were more prevalent among Black (52.0%) and female (38.9%) participants vs the overall population (33.3%).
Conclusion: In US Lp(a)HERITAGE participants, only 14% had an Lp(a) measurement pre-enrollment, despite having ASCVD. One-third of participants demonstrated Lp(a) levels ≥ 125 nmol/L, the threshold for high ASCVD risk, which was higher among Black (1/2) and female (2/5) participants, suggesting a greater need for Lp(a) testing in these groups to inform ASCVD risk mitigation.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.