Epidemiology
Over a quarter of 17,594 US patients with premature ASCVD have Lp(a) of 125 nmol/L or above, with Black patients showing the highest levels (J Clin Lipidol 2025)
Original title: Elevated lipoprotein(a) in patients with premature atherosclerotic cardiovascular disease: Insights from a large US real-world cohort
This study identified 17,594 patients with premature atherosclerotic cardiovascular disease (males under 55, females under 65) with recorded Lp(a) values from US Medicare, Medicaid and commercial insurance claims between January 2016 and September 2022, aiming to characterise the poorly described Lp(a) distribution in this high-risk group. Mean age was 50.9 (SD 10.1) years, most patients were female (68.9%), and half (52.2%) were not on lipid-lowering therapy. Lp(a) reached 125, 175, and 225 nmol/L or above in 26.8%, 18.8%, and 11.5% of patients respectively. Black patients had markedly higher median Lp(a) (111.0 nmol/L, Q1-Q3 51.1-206.0) than Asian (35.0, 14.4-100.0), Hispanic (31.0, 10.9-95.0), or White patients (31.0, 10.7-110). This is one of the largest US studies of Lp(a) distribution in premature ASCVD, highlighting both an undertreated population and a substantial racial disparity in Lp(a) burden.
Original abstract
Background: Patients experiencing premature cardiovascular events (males: <55 years; females: <65 years) represent a high-risk subgroup within the atherosclerotic cardiovascular disease (ASCVD) population. Elevated lipoprotein(a) (Lp[a]) is an independent, genetic, causal risk factor for ASCVD. Lp(a) distribution among patients with premature ASCVD is poorly characterized.
Objective: This study aimed to describe Lp(a) distribution and baseline characteristics in a large real-world sample of patients with premature ASCVD.
Methods: We identified 17,594 patients with premature ASCVD who had Lp(a) values from US Medicare, Medicaid, and commercial plans between January 2016-September 2022.
Results: Mean age (SD) was 50.9 (10.1) years, most patients were female (68.9%), and half (52.2%) were not prescribed lipid-lowering therapy. Lp(a) levels ≥125, ≥175, and ≥225 nmol/L occurred in 26.8%, 18.8%, and 11.5%, respectively. Black patients had higher median (Q1-Q3) Lp(a) levels (111.0 [51.1-206.0] nmol/L) than Asian (35.0 [14.4-100.0] nmol/L), Hispanic (31.0 [10.9-95.0] nmol/L), or White patients (31.0 [10.7-110] nmol/L).
Conclusion: In one of the largest studies in the US investigating Lp(a) distribution in premature ASCVD, we found over a quarter of patients had elevated Lp(a) (≥125 nmol/L).
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.