Despite High Awareness of Lp(a) as a CVD Risk Factor, Testing Rates Are Low

Most clinicians in the US see lipoprotein A (Lp[a]) as a useful tool in cardiovascular risk stratification, according to a new survey. However, the respondents were less certain about what to do with patients who have elevated levels of Lp(a), in part owing to a lack of approved Lp(a)-targeting therapies.¹

About half of respondents said they would prescribe a proven Lp(a)-targeted therapy to patients with recurrent cardiovascular disease, and a similar number said they would prescribe it to patients with premature cardiovascular disease. The findings were reported in the American Journal of Preventative Cardiology.

There is no shortage of evidence implicating Lp(a) as a causal risk factor for atherosclerotic cardiovascular disease, the study authors explained.

“Lp(a) levels have been recently documented to have a linear relationship with cardiovascular event risk in a large meta-analysis with a mean follow-up of 3.0 years for both baseline as well as on-statin Lp(a) levels,” they noted.²

Furthermore, the authors said their own research suggests Lp(a) is the strongest predictor of future atherosclerotic cardiovascular events in persons with known atherosclerotic cardiovascular disease.³

The investigators noted that the American Heart Association proposes people with a personal or family history of atherosclerotic cardiovascular disease and women with hypercholesterolemia be tested for Lp(a) and the US National Lipid Association suggests all adult patients be tested at least once for Lp(a). Yet, such testing rarely happens. A 2023 study of real-world data from the US suggests that less than 1% of the country’s population has had Lp(a) tested.⁴

There is evidence, however, that tools like pre-procedure electronic health record reminders can boost rates of testing, the authors noted.¹

The investigators wanted to gain a clearer understanding of the perceptions of clinicians with regard to Lp(a) and its association with atherosclerotic cardiovascular disease, as well as their thoughts with regard to testing, barriers to testing, and the potential uses of Lp(a)-targeting therapies.

They worked with a medical survey company to send an electronic survey to clinicians practicing in the US for at least 5 years. A total of 2,002 clinicians responded, the plurality of whom were primary care providers (47%). The rest specialized in cardiology (35%), endocrinology (9%), and neurology (9%).

The providers had a high level of awareness of Lp(a) as a significant risk factor for cardiovascular disease (81%), with 77% of respondents agreeing that Lp(a) is a helpful risk-stratification tool.

While only a minority (41%) of clinicians thought universal Lp(a) testing was necessary, approximately 7 in 10 clinicians said they thought it was warranted in patients with premature cardiovascular disease, patients with a family history of premature cardiovascular disease, and patients with recurrent cardiovascular disease events.

When asked why they thought Lp(a) testing was so limited despite relative agreement that it is important, the clinicians cited a lack of specific guidelines on how to manage patients with elevated Lp(a), a lack of harmonized guidelines on who should be tested, and a lack of awareness of Lp(a) as an important risk factor for atherosclerotic cardiovascular disease as barriers to testing. They also cited a lack of currently approved Lp(a)-lowering therapies as a barrier.

When asked about potential future Lp(a)-targeting therapies, the respondents most commonly said they would want to see cardiovascular outcome data and long-term safety and efficacy data before adopting such a therapy.

In response to a question about which patients they might prescribe Lp(a)-lowering therapies to, 47% said they would consider prescribing it to patients with premature cardiovascular disease, and 51% said they would consider prescribing it to patients with recurrent cardiovascular disease events.

The authors said these data represent the most comprehensive survey on the topic to date.

“Our results are hopefully useful to guide the prioritization of efforts to increase awareness, patient populations to be tested, as well as priorities to focus on in the development and use of newer therapeutic strategies,” they concluded.

References:

1. Wong ND, Fan Y, Fan W, Ward JH, Schludi B, Hu X. Clinician awareness, testing, and treatment for lipoprotein(a): Results from a large US national survey. Am J Prev Cardiol. 2025;25:101388. doi:10.1016/j.ajpc.2025.101388
2. Willeit P, Ridker PM, Nestel PJ, et al. Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials. Lancet. 2018;392(10155):1311-1320. doi:10.1016/S0140-6736(18)31652-0
3. Wong ND, Zhao Y, Xiang P, Coll B, López JAG. Five-year residual atherosclerotic cardiovascular disease risk prediction model for statin-treated patients with known cardiovascular disease. Am J Cardiol. 2020;137:7-11. doi:10.1016/j.amjcard.2020.09.043
4. Hu X, Cristino J, Gautam R, et al. Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study. Am J Prev Cardiol. 2023;14:100476. doi:10.1016/j.ajpc.2023.100476