Daijiworld Media Network – New Delhi
New Delhi, Feb 19: A majority of clinicians in the United States view lipoprotein(a), or Lp(a), as a valuable tool in assessing cardiovascular risk, according to a new survey published in the American Journal of Preventive Cardiology. However, many remain unsure about how to manage patients with elevated Lp(a) levels, largely due to the absence of approved therapies specifically targeting the biomarker.
The survey, conducted among 2,002 US-based clinicians with at least five years of practice experience, found that 81% recognised Lp(a) as a significant risk factor for cardiovascular disease, while 77% agreed it is helpful for risk stratification. Nearly half of respondents were primary care providers (47%), followed by cardiologists (35%), endocrinologists (9%), and neurologists (9%).
Study authors noted there is substantial evidence implicating Lp(a) as a causal factor in atherosclerotic cardiovascular disease (ASCVD). Recent meta-analyses have demonstrated a linear relationship between Lp(a) levels and cardiovascular event risk, both at baseline and in patients on statin therapy, with a mean follow-up of three years.
The investigators added that their own research suggests Lp(a) may be the strongest predictor of future atherosclerotic cardiovascular events in patients with established ASCVD.
Despite this growing body of evidence, testing rates remain strikingly low. While organisations such as the American Heart Association recommend testing in individuals with a personal or family history of ASCVD — and the National Lipid Association advises that all adults be tested at least once — real-world data from 2023 indicate that less than 1% of the US population has undergone Lp(a) testing.
Only 41% of surveyed clinicians supported universal Lp(a) testing. However, about 70% said testing is warranted in patients with premature cardiovascular disease, those with a family history of premature disease, and those experiencing recurrent cardiovascular events.
When asked about barriers, respondents cited:
• Lack of clear, harmonised guidelines on who should be tested
• Limited guidance on managing patients with elevated Lp(a)
• Low awareness of Lp(a) as a major risk factor
• Absence of approved Lp(a)-lowering therapies
The authors noted that practical interventions — such as electronic health record reminders before procedures — could improve testing uptake.
With several investigational Lp(a)-targeting therapies in development, clinicians expressed cautious optimism. When asked what would be required before prescribing such treatments, most respondents emphasised the need for robust cardiovascular outcomes data, along with long-term safety and efficacy evidence.
Regarding potential prescribing patterns:
• 47% said they would consider Lp(a)-lowering therapy for patients with premature cardiovascular disease
• 51% would consider it for patients with recurrent cardiovascular events
The authors described the survey as the most comprehensive to date on clinicians’ perceptions of Lp(a), testing practices, and therapeutic expectations.
“Our results are hopefully useful to guide the prioritisation of efforts to increase awareness, define patient populations to be tested, and focus research on the development and appropriate use of newer therapeutic strategies,” the authors concluded.
The findings underscore a growing recognition of Lp(a)’s role in cardiovascular risk — while also highlighting the gap between scientific understanding and real-world clinical implementation.