Testing
Just 0.8% of a diverse 266,612-person US cohort had ever been tested for Lp(a), with Black participants 32% less likely to be tested, All of Us study finds (JACC Adv 2025)
Original title: Prevalence and Correlates of Lipoprotein(a) Testing in a Diverse Cohort of U.S. Adults
This study assessed Lp(a) testing prevalence and its correlates using the All of Us Research Study, a diverse US cohort of 266,612 adults 18 or older with electronic medical record data through 2022 (mean age 52, 61% women, 53% non-Hispanic White). Only 2,172 participants (0.8%) had ever undergone Lp(a) testing, 86% of whom already had clinical cardiovascular disease. Compared with non-Hispanic White individuals, non-Hispanic Black individuals had 32% lower odds of Lp(a) testing (OR 0.68, 95% CI 0.58-0.81); less than high school education (OR 0.34, 95% CI 0.25-0.44), unemployment (OR 0.76, 95% CI 0.68-0.85) and disability (OR 0.77, 95% CI 0.65-0.91) were each associated with 23% to 66% lower odds of testing. Non-Lp(a) lipid abnormalities (OR 5.64, 95% CI 4.72-6.79) and prevalent cardiovascular disease (OR 3.21, 95% CI 2.76-3.74) were the strongest positive correlates. The authors conclude Lp(a) testing prevalence is exceedingly low overall, and particularly so for Black individuals and those with socioeconomic disadvantage, underscoring a health equity imperative in expanding Lp(a) testing.
Original abstract
Background: Once-per-lifetime lipoprotein(a) [Lp(a)] testing is recommended by multiple professional societies during cardiovascular disease risk assessment.
Objective: The purpose of this study was to assess the prevalence and identify correlates of Lp(a) testing in a real-world, diverse sample.
Methods: Participants were ≥18 years of age from the All of Us Research Study who shared electronic medical record information through 2022 (N = 266,612). Completion of Lp(a) testing was defined by the following: presence of Lp(a) values, Systematized Nomenclature of Medicine Clinical Terms or Logical Observation Identifiers Names and Codes electronic health record listings for Lp(a) testing, or an Internal Classification of Diseases-10 code for elevated Lp(a). Multivariable logistic regression assessed the association of demographic, socioeconomic, and clinical variables with Lp(a) testing.
Results: The mean age was 52 years, 61% were women, and 53% were non-Hispanic White. A total of 2,172 (0.8%) underwent Lp(a) testing, 86% of whom had clinical cardiovascular disease. Compared to non-Hispanic White individuals, non-Hispanic Black individuals (OR: 0.68, 95% CI: 0.58-0.81) had 32% lower odds of Lp(a) testing. Less than high school education (OR: 0.34, 95% CI: 0.25-0.44), unemployment (OR: 0.76, 95% CI: 0.68-0.85), and disability (OR: 0.77, 95% CI: 0.65-0.91) were associated with a 23% to 66% lower odds of Lp(a) testing. Among clinical factors, non-Lp(a) lipid abnormality (OR: 5.64, 95% CI: 4.72-6.79) and prevalent cardiovascular disease (OR: 3.21, 95% CI: 2.76-3.74) were strongly associated with Lp(a) testing.
Conclusions: The prevalence of Lp(a) testing among US adults is exceedingly low, especially for non-Hispanic Black individuals and those with socioeconomic risk. These results underline the importance of emphasizing health equity in Lp(a) testing expansion.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.