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. 2025 May 30;4(6 Pt 1):101826.
doi: 10.1016/j.jacadv.2025.101826. Online ahead of print.

Prevalence and Correlates of Lipoprotein(a) Testing in a Diverse Cohort of U.S. Adults

Alexander C Razavi  1 , LaTonia C Richardson  2 , Fátima Coronado  2 , Hubert W Vesper  3 , Alicia Lyle  3 , Harpreet S Bhatia  4 , Sotirios Tsimikas  4 , Arshed A Quyyumi  1 , Viola Vaccarino  1 , Danny J Eapen  1 , Ijeoma Isiadinso  1 , Anurag Mehta  5 , Adithya K Yadalam  1 , Jeffery Osei  1 , Terry A Jacobson  1 , Zhiqi Yao  6 , Omar Dzaye  6 , Seth S Martin  6 , Khurram Nasir  7 , Michael D Shapiro  8 , Michael J Blaha  6 , Seamus P Whelton  6 , Roger S Blumenthal  6 , Laurence S Sperling  9
Affiliations

Prevalence and Correlates of Lipoprotein(a) Testing in a Diverse Cohort of U.S. Adults

Alexander C Razavi et al. JACC Adv. .

Abstract

Background: Once-per-lifetime lipoprotein(a) [Lp(a)] testing is recommended by multiple professional societies during cardiovascular disease risk assessment.

Objective: The purpose of this study was to assess the prevalence and identify correlates of Lp(a) testing in a real-world, diverse sample.

Methods: Participants were ≥18 years of age from the All of Us Research Study who shared electronic medical record information through 2022 (N = 266,612). Completion of Lp(a) testing was defined by the following: presence of Lp(a) values, Systematized Nomenclature of Medicine Clinical Terms or Logical Observation Identifiers Names and Codes electronic health record listings for Lp(a) testing, or an Internal Classification of Diseases-10 code for elevated Lp(a). Multivariable logistic regression assessed the association of demographic, socioeconomic, and clinical variables with Lp(a) testing.

Results: The mean age was 52 years, 61% were women, and 53% were non-Hispanic White. A total of 2,172 (0.8%) underwent Lp(a) testing, 86% of whom had clinical cardiovascular disease. Compared to non-Hispanic White individuals, non-Hispanic Black individuals (OR: 0.68, 95% CI: 0.58-0.81) had 32% lower odds of Lp(a) testing. Less than high school education (OR: 0.34, 95% CI: 0.25-0.44), unemployment (OR: 0.76, 95% CI: 0.68-0.85), and disability (OR: 0.77, 95% CI: 0.65-0.91) were associated with a 23% to 66% lower odds of Lp(a) testing. Among clinical factors, non-Lp(a) lipid abnormality (OR: 5.64, 95% CI: 4.72-6.79) and prevalent cardiovascular disease (OR: 3.21, 95% CI: 2.76-3.74) were strongly associated with Lp(a) testing.

Conclusions: The prevalence of Lp(a) testing among US adults is exceedingly low, especially for non-Hispanic Black individuals and those with socioeconomic risk. These results underline the importance of emphasizing health equity in Lp(a) testing expansion.

Keywords: cardiovascular disease; lipoprotein(a); preventive cardiology; risk assessment; risk factor; testing.

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Conflict of interest statement

Funding support and author disclosures Bhatia reports consulting fees from Abbott, Arrowhead, Kaneka, and Novartis and is supported by National Institutes of Health, Grant 1K08HL166962. Razavi is supported by the National Heart, Lung, and Blood Institute of the National Institutes of Health, Grants F32HL172499 and L30HL175751. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Central Illustration
Central Illustration
Prevalence and Correlates of Lp(a) Testing in U.S. Adults Less than 1% of all individuals were tested for Lp(a), with notable disparities across demographics, socioeconomic status, clinical risk factors, and chronic conditions.
Figure 1
Figure 1
Lp(a) Tests Performed Among All of Us Study Participants (1993-2021) Lp(a) testing has increased over time, but absolute testing remains low. Lp(a) = lipoprotein(a).
See this image and copyright information in PMC

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