Statins
Adding Lp(a) to SCORE2 reclassified most moderate-risk patients to high risk and made 61% eligible for statins, 140-subject study finds (Biomedicines 2025)
Original title: Reclassification of Low or Intermediate Cardiovascular Risk by Determining Lipoprotein(a) Levels
This study invited 140 subjects with SCORE2-estimated low or moderate cardiovascular risk (mean age 54.3 ± 8.1 years, 62.9% women) for Lp(a) testing, reclassifying those above 50 mg/dL into a higher-risk category and reassessing statin eligibility against treatment targets. Median Lp(a) was 15.2 mg/dL (IQR 6.7-44.5), and 22.1% of the cohort had Lp(a) above 50 mg/dL, with no differences in age, sex or lipid profile between those above and below that threshold except higher alkaline phosphatase in the elevated-Lp(a) group. After incorporating Lp(a) into the SCORE2 assessment, 22.6% of initially low-risk individuals were reclassified to moderate risk and 77.4% of moderate-risk individuals were reclassified to high risk, and 61.4% (86 subjects) became eligible for statin treatment as a result. This small study demonstrates a substantial, concrete clinical impact of adding a single Lp(a) measurement to standard risk scoring.
Original abstract
Background: Lipoprotein(a) [Lp(a)] is a modifier of cardiovascular risk, and it should be determined at least once in a lifetime. Methods: Subjects with low or moderate cardiovascular risk, estimated by SCORE2, were invited to have a determination of Lp(a), and those with Lp(a) > 50 mg/dL were classified into a higher-risk category. Eligibility of statins was assessed according to treatment targets. Results: We analyzed 140 subjects, with a mean age of 54.3 (8.1) years and 62.9% women. The median Lp(a) was 15.2 (interquartile range: 6.7-44.5) mg/dL, and 22.1% of the cohort had Lp(a) > 50 mg/dL. No differences were observed in mean age, sex, or lipid profile in subjects with Lp(a) below or above 50 mg/dL; alkaline phosphatase (ALP) was significantly higher in subjects with Lp(a) > 50 mg/dL. After incorporating Lp(a) values into the SCORE-2 assessment, 22.6% of individuals initially of low risk were reclassified as moderate risk, and 77.4% were reclassified from moderate to high risk; moreover, 61.4% (86 subjects) were considered eligible for treatment with statins. Conclusions: Our results highlight that 22.1% of the subjects classified as low or moderate cardiovascular risk by SCORE-2 are reclassified to higher risk, and 61.4% were eligible for statin treatment as a result of Lp(a) testing.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.