A recent JACC analysis of the Epic Cosmos database suggests lipoprotein(a) screening is still one of cardiology’s most neglected risk assessment tools, representing a serious gap in the way we evaluate patients’ CVD risk.
- Lipoprotein(a) is a fat molecule that significantly increases CVD risk, with roughly 20% of individuals having elevated levels above 50 mg/dL.
- Despite its well-established relationship with MACE, Lp(a) testing remains widely underutilized in clinics with limited data available until now.
- Currently statins and ezetimibe are the main drugs for lowering Lp(a) levels, but there’s a field of promising Lp(a) therapies on the horizon.
To learn more about Lp(a) testing trends, researchers searched for Lp(a) screening patterns in the Epic Cosmos database from 2015-2024 across more than 300M patients and found both progress and persistent gaps…
- Total distinct patients tested increased dramatically from 14.5k in 2015 to 309k in 2024 (a 21x increase).
- However, annual testing rates rose from just 0.03% in 2015 to only 0.24% in 2024, so only 728k total patients (0.2% of the U.S. population) were tested the entire decade.
- Testing was mostly in adults aged 50-65 years (34.8%), with similar rates between males (51.8%) and females (48.2%).
Despite the growth in the raw number of patients tested, the persistently low testing rate means that the vast majority of at-risk patients fly under the radar despite growing awareness of Lp(a)’s risk implications, but there are two important details to highlight.
- Testing rates varied from state to state, with California (11.6%), Ohio (8.6%), and Texas (7.6%) accounting for the highest testing volumes.
- During the study, Lp(a) testing methods shifted from mass-based assays (mg/dL) to the recommended molar assays (nmol/L), which reached 64.2% of tests by 2024.
The Takeaway
Even with a 21x increase over the past decade, Lp(a) testing in the U.S. is still seriously underutilized at just 0.2% of the population annually and far below what would be needed to identify the potential 20% of people with elevated levels. While some aspects of Lp(a) screening have improved, it may be that we need a true Lp(a) treatment to emerge before screening becomes a priority.
