Testing
Lp(a) testing rose from 3,052 to 8,425 orders a year across a US health system, cohort of 450,412 (Am J Prev Cardiol 2026)
Original title: Trends in lipoprotein(a) testing and impact on clinical care: A contemporary systemwide analysis
Systemwide electronic health record analysis of 450,412 outpatients with at least one lipid panel order (2022-2024), of whom 3.7% (16,476) had Lp(a) tested (50.5% female, 61.8% White; 68.9% without established ASCVD). Lp(a) orders rose from 3052 in 2022 to 8425 in 2024, with cardiologists' share of orders falling from 75.5% to 62.9% as other specialties ordered more. Among those tested, 67.0% had normal Lp(a) (below 75 nmol/L), 12.2% intermediate risk (75-125 nmol/L), 11.3% high risk (125-200 nmol/L) and 9.4% very-high-risk (200 nmol/L or more); lipid-lowering therapy initiation or escalation rose stepwise across these categories (12.8%, 17.5%, 20.2%, 22.1%, p<0.0001). The authors conclude Lp(a) testing, though still low overall, increased substantially over time, with high-risk levels found regardless of ASCVD status and associated with more aggressive treatment, supporting systematic efforts to expand awareness and testing.
Original abstract
Aims: Elevated lipoprotein(a) [Lp(a)] is an independent, causal risk factor for atherosclerotic cardiovascular disease (ASCVD), yet testing remains low. As our health system has expanded its efforts to increase Lp(a) awareness, we evaluated testing rates and their impact on care.
Methods: Lp(a) testing rates were collected through electronic health record queries between 1/1/2022 to 12/31/2024. Baseline demographics, ASCVD status, Lp(a) testing rates by specialty, lipid lowering therapy (LLT) prescriptions and number of cardiology referrals were collected.
Results: 450,412 outpatients had ≥1 lipid panel order and 3.7 % (N = 16,476) had Lp(a) tested. Of those who had Lp(a) measured, 50.5 % were female and 61.8 % identified as White. Most Lp(a) orders were for patients without established ASCVD (68.9 %). Between 2022-2024, Lp(a) orders increased from 3052 to 8425. Most orders were placed by cardiologists, although their proportion decreased (75.5 % in 2022 vs. 62.9 % in 2024) as orders from other specialties increased. We found 67.0 % of patients with normal Lp(a) (<75 nmol/L) levels, 12.2 % with intermediate risk (75 ≥ Lp(a) < 125 nmol/L), 11.3 % with high risk (125 ≥ Lp(a) < 200 nmol/L) and 9.4 % with very high-risk values (≥200 nmol/L). Across the same Lp(a) categories, LLT initiation/escalation rates were 12.8 %, 17.5 %, 20.2 % and 22.1 %. There was a positive association between LLT initiation/escalation and Lp(a) range (p < 0.0001).
Conclusion: While Lp(a) testing was low, it increased substantially over time. High risk Lp(a) levels were found irrespective of ASCVD status and were associated with more aggressive treatment. Systematic strategies to increase Lp(a) awareness and testing are warranted to mitigate cardiovascular risk.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 17 August 2026. Methods.