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. 2025 Nov:289:171-179.
doi: 10.1016/j.ahj.2025.06.010. Epub 2025 Jun 21.

Global lipoprotein (a) testing trends from 2015 to 2023

Muhammad Hanif  1 , Laibah Arshad Khan  2 , Anandita Kulkarni  3 , Harpreet S Bhatia  4 , Michael J Wilkinson  4 , Ahmed Mustafa Rashid  5 , Nicholas W S Chew  6 , Subhash Banerjee  5 , Javed Butler  7 , Michael D Shapiro  8 , Muhammad Shahzeb Khan  9
Affiliations

Global lipoprotein (a) testing trends from 2015 to 2023

Muhammad Hanif et al. Am Heart J. 2025 Nov.

Abstract

Background: 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.

Methods: 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.

Results: 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.

Conclusion: 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.

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Conflict of interest statement

Conflict of interest M.J.W is a consultant to Amarin, Regeneron, Kaneka, and The Kinetix Group; reports advisory board fees from Novartis and NewAmsterdam and speaker fees from Regeneron; received grant support from Amgen (investigator-initiated study) and support through an institutional consulting agreement with Novartis paid to his institution for advising on research; and has contracted research grants to his institution with Amgen, Novartis, Ionis, Lilly, and Mineralys. N.W.S.C reports research support from the National University Health System’s Seed Fund (grant No. NUHSRO/2022/RO5+6/Seed-Mar/03) and Clinician Scientist Program (grant No. NCSP2.0/2024/NUHS/NCWS), National Medical Research Council Research Training Fellowship (grant No. MH 095:003/008-303), and National University of Singapore Yong Loo Lin School of Medicine’s Academic Fellowship Scheme. S.B is a board member for Elsevier, Cardiovascular Innovations foundation; has received institutional research grant from GE, Esperion, and Novartis; and has received honoraria from Boston Scientific Corporation and Medtronic. J.B has served as a consultant to Abbott, American Regent, Amgen, Applied Therapeutic, AskBio, Astellas, AstraZeneca, Bayer, Boehringer Ingelheim, Boston Scientific, Bristol Myers Squibb, Cardiac Dimension, Cardiocell, Cardior, CSL Bearing, CVRx, Cytokinetics, Daxor, Edwards, Element Science, Faraday, Foundry, G3P, Innolife, Impulse Dynamics, Imbria, Inventiva, Ionis, Lexicon, Lilly, LivaNova, Janssen, Medtronics, Merck, Occlutech, Owkin, Novartis, Novo Nordisk, Pfizer, Pharmacosmos, Pharmain, Prolaio, Regeneron, Renibus, Roche, Salamandra, Sanofi, SC Pharma, Secretome, Sequana, SQ Innovation, Tenex, Tricog, Ultromics, Vifor, and Zoll. M.D.S is a consultant to Ionis, Novartis, Regeneron, Aidoc, Shanghai Pharma Biotherapeutics, Kaneka, and Novo Nordisk; reports advisory board fees from Amgen, Agepha, Ionis, Novartis, Arrowhead, and Merck; and has contracted research grants to his institution with Amgen, Boehringer Ingelheim, 89Bio, Esperion, Genentech, Novartis, Ionis, Merck, and NewAmsterdam. M.S.K reports receiving fees from Bayer and Novartis. The rest of the authors have no conflicts of interest to report.

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