Testing
Only 1.4% of ASCVD-free and 4.9% of ASCVD patients were ever tested for Lp(a) over 18 years, but testing tracked with more lipid-lowering therapy use, 419,812-patient Midwest cohort finds (Am J Prev Cardiol 2025)
Original title: Lipoprotein(a) Testing for Cardiovascular Risk Assessment and Use of Lipid-Lowering Therapy in a Large Midwest Cohort
This retrospective analysis examined patients aged 40-79 with at least two ambulatory visits to a Midwestern US healthcare system between 2018 and 2022, using Lp(a) testing records back to 2004 to characterise testing frequency and its relationship with lipid-lowering therapy (LLT) use. Among 419,812 patients (median age 61, IQR 52-71; 61% with dyslipidaemia, 11% with ASCVD), only 1.4% of those without prior ASCVD and 4.9% of those with ASCVD were ever tested for Lp(a) over the 18-year window. Compared with patients with normal Lp(a), those with elevated Lp(a) (50 mg/dL or 125 nmol/L or above) had higher LLT use across every ASCVD risk category, including low-risk patients (59% vs. 47%) and those with established ASCVD (88% vs. 85%). The authors conclude Lp(a) testing rates, while improved, remain very low, particularly given how consistently a positive test appears to influence treatment decisions once ordered.
Original abstract
Purpose Of The Research: The atherogenic lipoprotein(a) [Lp(a)] is recommended to be measured at least once in each adult person's lifetime. However, the testing frequency and its impact on lipid-lowering therapy is uncertain.
Methods: This retrospective analysis included patients 40-79 years old with at least two ambulatory clinic visits to a Midwestern healthcare system between 2018-2022. Within those patients, Lp(a) testing dates to 2004. Parameters included age, sex, race, traditional ASCVD risk factors, Lp(a) levels, and lipid-lowering therapy (LLT) prevalence. Lp(a) was considered elevated if Lp(a) ≥50 mg/dL or ≥125 nmol/L, respectively.
Results: Patients (n = 419,812) in the sample had a median (IQ range) age of 61 (52 - 71) years, with 61 % with dyslipidemia and 11 % ASCVD. Over 18 years, only 1.4 % of those without prior ASCVD and 4.9 % of those with ASCVD were tested for Lp(a). Median (IQR) Lp(a) levels in patients with and without ASCVD in mass and particle number were 20 (8, 55) mg/dL and 47 (19, 129) nmol/L, and 27 (10, 76) mg/dL and 59 (20, 174) nmol/L, respectively. Compared to those with normal Lp(a) levels, the prevalence of LLT was higher in patients with elevated Lp(a) across ASCVD risk categories including low risk patients (59 % vs 47 %) and those with established ASCVD (88 % vs 85 %).
Conclusions: Although testing for Lp(a) has improved, there is room for significant improvement, particularly in those with ASCVD. The higher use of LLT in all risk categories indicate that Lp(a) testing may have influenced treatment decisions.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.