Most US clinicians view lipoprotein(a) [Lp(a)] as a valuable tool for cardiovascular risk stratification, according to a new survey published in the American Journal of Preventive Cardiology. However, many respondents expressed uncertainty about how to manage patients with elevated Lp(a) levels, citing the lack of approved Lp(a)-targeted therapies as a key challenge.
Approximately half of respondents said they would prescribe a proven Lp(a)-lowering therapy to patients with recurrent cardiovascular disease (CVD), and a similar proportion said they would use such therapy for patients with premature CVD.
Overall awareness of Lp(a) as a significant cardiovascular risk factor was high, with 81% of clinicians recognizing its importance and 77% agreeing that it is a useful risk-stratification tool.
The study authors noted that substantial evidence supports Lp(a) as a causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Recent meta-analyses have demonstrated a linear relationship between Lp(a) levels and cardiovascular event risk over a mean follow-up of three years, including both baseline and on-statin Lp(a) levels. In addition, the investigators’ prior research found that Lp(a) was the strongest predictor of future ASCVD events among patients with established disease.
Despite recommendations from organizations such as the American Heart Association and the National Lipid Association—which advise targeted or at least one-time Lp(a) testing in adults—screening rates remain extremely low. Real-world US data from 2023 indicate that fewer than 1% of individuals have been tested for Lp(a).
Researchers noted that electronic health record reminders implemented before procedures may help improve testing rates.
To better understand clinician perspectives, investigators partnered with a medical survey company to distribute an electronic questionnaire to US clinicians with at least five years of practice experience. A total of 2,002 clinicians responded: 47% were primary care providers, 35% specialized in cardiology, and 9% each in endocrinology and neurology.
While only 41% supported universal Lp(a) screening, roughly 70% believed testing is warranted in patients with premature CVD, a family history of premature CVD, or recurrent CVD events.
When asked about barriers to testing, clinicians cited unclear or inconsistent guidelines on whom to test and how to manage elevated Lp(a), limited awareness among providers, and the absence of approved Lp(a)-lowering therapies.
Looking ahead, most respondents said they would require robust cardiovascular outcomes data, along with long-term safety and efficacy evidence, before adopting new Lp(a)-targeted treatments.
The authors described the findings as the most comprehensive survey on clinician perceptions of Lp(a) to date. They concluded that the results may help guide future efforts to improve awareness, refine testing strategies, and prioritize therapeutic development.
References
Wong ND, Fan Y, Fan W, Ward JH, Schludi B, Hu X. Clinician awareness, testing, and treatment of lipoprotein(a): Results from a large US national survey. Am J Prev Cardiol. 2025;25:101388. doi:10.1016/j.ajpc.2025.101388
Willeit P, Ridker PM, Nestel PJ, et al. Baseline and on-statin lipoprotein(a) levels for prediction of cardiovascular events: An individual patient–data meta-analysis of statin outcome trials. Lancet. 2018;392(10155):1311-1320. doi:10.1016/S0140-6736(18)31652-0
Wong ND, Zhao Y, Xiang P, Coll B, López JAG. Five-year residual atherosclerotic cardiovascular disease risk prediction model for statin-treated patients with established cardiovascular disease. Am J Cardiol. 2020;137:7-11. doi:10.1016/j.amjcard.2020.09.043
Hu X, Cristino J, Gautam R, et al. Characteristics and lipid-lowering treatment patterns among patients tested for lipoprotein(a): A real-world US study. Am J Prev Cardiol. 2023;14:100476. doi:10.1016/j.ajpc.2023.100476