Rising Trends in Lipoprotein(a) Testing for Cardiovascular Risk Prediction

Recent research from the University of California San Diego School of Medicine indicates that testing for lipoprotein(a)—a genetic marker linked to increased heart disease risk—remains relatively uncommon in the United States, despite showing modest growth over the past decade. This genetic cholesterol particle, elevated levels of which are associated with higher incidences of heart attack, stroke, and aortic valve disease, is present in approximately 20% of Americans. However, routine testing rates are still very low.

The study analyzed over 300 million patient records from the Epic Cosmos national database, covering all 50 states. Findings revealed that from 2015 to 2024, only about 728,550 individuals, which constitutes roughly 0.2% of the U.S. population, underwent lipoprotein(a) testing. Although testing increased significantly from around 14,000 in 2015 to over 300,000 in 2024, these figures are far below the recommended levels for effectively identifying those at risk.

European countries have been actively promoting widespread lipoprotein(a) testing as an early indicator for cardiovascular disease, but the United States continues to lag behind in adopting these guidelines. Experts emphasize that increasing testing could help detect high-risk individuals earlier, especially since no current therapies can directly lower Lp(a) levels, although several are in advanced clinical trials.

The study also highlighted disparities in testing practices. Adults aged 50 to 65 were most commonly tested, with little difference between men and women. However, racial and ethnic disparities are evident: less than 10% of tested individuals were Black, and only about 7% identified as Hispanic or Latino, despite evidence that these groups are disproportionately affected by cardiovascular risks. Geographically, states like California, Ohio, and Texas conducted the most tests, whereas some states showed minimal activity, suggesting uneven awareness and clinical practice.

Additionally, an evolution in testing methods was observed. In 2015, the majority of tests used older mass-based assays, but by 2024, around two-thirds employed molar assays, which are more accurate in measuring the particle count of Lp(a). Since lipoprotein(a) levels are primarily determined by genetics and remain stable throughout life, identifying high levels is critical for risk assessment, yet no widely available therapies currently exist to reduce it. As new treatments are developed, broader testing could facilitate targeted interventions.

Despite these advancements, national guidelines recommend at least one Lp(a) test during a lifetime for adults, particularly those with a family history of heart disease. Still, fewer than 1 in 500 Americans undergo testing annually, underscoring the need for increased awareness and equity in healthcare access. Experts advocate for more clinician education, clearer policies, and insurance coverage to bridge these gaps.

Future studies aim to explore why certain populations and regions are slower to adopt Lp(a) testing and to monitor how testing patterns change as specialized therapies emerge. Ensuring equitable access to these diagnostic tools is essential to reducing cardiovascular disease burden overall.

source: https://medicalxpress.com/news/2025-09-lab-cardiac-events-rare.html