Lipoprotein(a) tests could transform patient care—is it time for universal screening?
The cardiology community may soon see a major shift in how it identifies and manages patients at risk for heart disease—and it’s coming from a particle many physicians have never tested for: Lipoprotein(a), or Lp(a).
“I would say that Lp(a) represents the most important potential paradigm shift in cardiovascular disease prevention that we’ll experience over the next five to 10 years. It’s a triple threat, because it increases inflammation, increases thrombosis and increases atherosclerosis. All three will conspire to cause cardiovascular events, heart attack, stroke and peripheral arterial disease," explained Seth Baum, MD, chairman of the Board for the Family Heart Foundation, past president of the American Society for Preventive Cardiology, clinical affiliate professor of biomedical science at Florida Atlantic University, and chief medical officer of Flourish Research.
Lp(a) is a small LDL-like particle with an added apolipoprotein(a) tail that makes it more dangerous. Research shows it is highly prevalent, affecting about 20% of the population, with even higher rates among women, African Americans and South Asians, yet it remains dramatically underdiagnosed. “Fewer than 5% of people have been tested, and it’s probably significantly less,” Baum said.
The Family Heart Foundation is pushing to change that. The group is advocating for universal Lp(a) screening, joining European, Canadian, and National Lipid Association guidelines that have pushed for similar policies. Baum said the American Heart Association is also expected to release its own guidance on Lp(a) screening. He notes that in some cases, Lp(a) testing could identify a hidden cause of “residual risk” for cardiovascular events in patients whose LDL cholesterol is already well controlled with statins and other therapies.
A growing body of evidence suggests even moderately elevated Lp(a) levels can increase the likelihood of recurrent events. Baum pointed to a key study presented at the European Society of Cardiology (ESC) meeting last year and published earlier in 2025 showing how Lp(a) impacted a large population of patients with atherosclerotic cardiovascular disease (ASCVD) from U.S. medical claims between 2012 and 2022. The claims data include 340 million individuals, of which 273,770 had ASCVD with elevated Lp(a). These higher levels were associated with continuously increasing risk of recurrent ASCVD events, regardless of sex and race or ethnicity.
"Those people have already had cardiovascular events or have underlying peripheral arterial disease, and there was a continuous relationship of Lp(a) levels and risk of recurrent events. And in a very scary way, that risk increases even when a patient is considered today to have normal Lp(a) levels. So we are going to have to really readjust how we assess Lp(a) as time goes on and who we consider to be at risk and who not at risk," Baum explained.
He said Lp(a) might be a missing link for residual cardiac risk seen in patients who appeared to be doing everything right and had good lab tests, but then suffer a heart attack. Elevated Lp(a) is very prevalent and it may present an opportunity to identify these patients and intervene to prevent large numbers of cardiac events each year.
While there are no widely available drugs yet that specifically target Lp(a), multiple pharmaceutical and biotech companies are developing agents using antisense, RNA interference, and gene-editing approaches. Lipoprotein apheresis, an FDA-approved therapy, is available for select patients, although it is not widely available. But, Baum argues there is value in testing now, even before these new treatments reach the market. He said when people identify a risk factor like Lp(a), they tend to make lifestyle changes with the goal of improving their health.
"We should be doing universal screening. It's really just a blood test," Baum said.
Because Lp(a) is almost entirely genetic, elevated levels are present from birth, making cascade screening of family members essential. “These people are at tremendous risk for accelerated atherosclerotic disease,” Baum said.
The Family Heart Foundation offers free Lp(a) testing and patient navigation services to help individuals understand their results and bring them to their physicians. Baum’s message to cardiologists is simple: “Understand this is a major risk factor. Understand it’s highly prevalent. Test your patients.”
He believes the coming decade could bring a fundamental change in prevention strategy: “In the not too distant future, there will likely be therapeutics available. But we need to know today who’s at risk so we can be ready to intervene.”
Dave Fornell has covered healthcare for more than 17 years, with a focus in cardiology and radiology. Fornell is a 5-time winner of a Jesse H. Neal Award, the most prestigious editorial honors in the field of specialized journalism. The wins included best technical content, best use of social media and best COVID-19 coverage. Fornell was also a three-time Neal finalist for best range of work by a single author. He produces more than 100 editorial videos each year, most of them interviews with key opinion leaders in medicine. He also writes technical articles, covers key trends, conducts video hospital site visits, and is very involved with social media. E-mail: [email protected]