Global lipoprotein (a) testing trends from 2015 to 2023

• Published in: The American heart journal Vol. 289; pp. 171 - 179
• Main Authors: Hanif, Muhammad, Khan, Laibah Arshad, Kulkarni, Anandita, Bhatia, Harpreet S., Wilkinson, Michael J., Rashid, Ahmed Mustafa, Chew, Nicholas W.S., Banerjee, Subhash, Butler, Javed, Shapiro, Michael D., Khan, Muhammad Shahzeb
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2025; Elsevier Limited
• Subjects: Adult; Adults; Age; Aged; Aorta; Aortic stenosis; Aspirin; Cardiovascular disease; Cardiovascular diseases; Cardiovascular Diseases - blood; Cardiovascular Diseases - epidemiology; Carotid arteries; Carotid artery; Carotid Stenosis - blood; Carotid Stenosis - epidemiology; Collaboration; Comorbidity; Congestive heart failure; Coronary artery disease; Coronary Artery Disease - blood; Coronary Artery Disease - epidemiology; Diabetes; Electronic health records; Ethnicity; Family medical history; Female; Genetics; Health risks; Heart diseases; Heart Failure - blood; Heart Failure - epidemiology; Humans; Hypertension; Ischemia; Ischemic Stroke - blood; Ischemic Stroke - epidemiology; Kidney diseases; Lipids; Lipoprotein(a) - blood; Lipoproteins; Male; Middle Aged; Patients; Peripheral Arterial Disease - blood; Peripheral Arterial Disease - epidemiology; Population studies; Retrospective Studies; Risk Assessment; Risk factors; Risk groups; Stroke; Subgroups; Trends; Vascular diseases; Vein & artery diseases; Womens health; United States > US
• DOI: 10.1016/j.ahj.2025.06.010
• ISSN: 0002-8703; 1097-6744

•Lp(a) testing remains low globally despite known ASCVD risk associations.•Testing increased from 0.009% in 2015 to 0.032% in 2023 across 141 million patients.•<1% of high-risk groups (CAD, HF, PAD) underwent Lp(a) testing in 2023.•Testing was highest in those with a family history of CAD (1.29% in 2023).•Integration of guideline-based Lp(a) testing and risk stratification is needed. Lipoprotein (a) [Lp(a)] is a known cardiovascular disease risk factor. Recent guidelines recommend Lp(a) testing once in all individuals, especially in those with premature cardiovascular disease, and family history of cardiovascular disease. Emerging Lp(a) lowering therapies have the potential to mitigate this risk. However, the current global trends in Lp(a) testing remain unknown. This study aimed to evaluate global patterns in Lp(a) testing over the past decade, including trends in high-risk and key demographic subgroups. We conducted a retrospective cohort study using the TriNetX Global Collaborative Network and identified comorbidities using the International Classification of Disease, Tenth Revision, and Clinical Modification (ICD-10-CM) codes. Study population included adults age (≥18 years) who underwent Lp(a) testing between January 2015 and December 2023. We assessed annual trends in Lp(a) testing overall and in high-risk subgroups, including coronary artery disease (CAD), peripheral artery disease (PAD), ischemic stroke, heart failure (HF), family history of CAD, carotid artery stenosis, and aortic stenosis. 141 million patients from 144 healthcare organizations were included. Lp(a) testing was conducted in 175,853 patients, with a mean age of 59.0 ± 16.9 years, 50% women and 63% white adults. Overall Lp(a) testing increased nominally from 0.009% in 2015 to 0.032% in 2023. Among different high-risk subgroups, Lp(a) testing was also considerably low and only had a modest gradual increase between 2015 and 2023 (CAD: 0.24%-0.85%; PAD: 0.20%-0.42%; Ischemic stroke: 0.61%-0.71%; HF: 0.19%-0.51%; Family history of CAD: 0.24%-1.29%; Carotid artery stenosis: 0.37%-0.90%; Aortic stenosis: 0.18%-0.56%). In 2023, all subgroups had <1% Lp(a) testing, except those with family history of CAD. Global Lp(a) testing rates remain low overall and in high-risk subgroups, emphasizing the need for education and implementation of guideline-recommended testing and risk stratification.