Despite High Awareness of Lp(a): Lipoprotein(a), commonly abbreviated as Lp(a), has steadily gained recognition over the past decade as a powerful and independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Yet, despite growing scientific evidence and widespread clinician awareness, real-world testing rates for Lp(a) remain strikingly low—particularly in the United States. A new clinician survey highlights a concerning gap between knowledge and action, raising important questions about how cardiovascular risk is currently assessed and managed.
High Awareness, Limited Action
According to a recent survey published in the American Journal of Preventative Cardiology, most clinicians practicing in the US acknowledge the clinical relevance of Lp(a). In fact, 81% of respondents identified Lp(a) as a significant cardiovascular risk factor, while 77% agreed it is a useful tool for cardiovascular risk stratification.
These findings align with a growing body of research demonstrating that Lp(a) is not merely associated with cardiovascular disease, but is a causal and genetically determined risk factor. Large-scale meta-analyses have shown a linear relationship between Lp(a) levels and cardiovascular event risk, both at baseline and among patients already receiving statin therapy. Some studies even suggest Lp(a) may be one of the strongest predictors of future cardiovascular events in patients with established ASCVD.
Despite this awareness, actual testing remains rare. Real-world data from 2023 indicate that less than 1% of the US population has ever undergone Lp(a) testing, underscoring a significant disconnect between evidence, clinician belief, and clinical practice.
Also read: The Bad Food a Cardiologist Actually Recommends for Better Heart Health
Who Was Surveyed?
To better understand this gap, researchers conducted one of the most comprehensive surveys on Lp(a) perceptions to date. Working with a medical survey company, they distributed an electronic questionnaire to clinicians who had been practicing in the US for at least five years.
A total of 2,002 clinicians responded, representing a broad cross-section of specialties:
- Primary care providers: 47%
- Cardiologists: 35%
- Endocrinologists: 9%
- Neurologists: 9%
This diverse respondent pool strengthens the relevance of the findings across multiple points of care in cardiovascular risk management.
Selective Testing Over Universal Screening
Interestingly, while clinicians broadly recognize the importance of Lp(a), fewer support universal testing. Only 41% of respondents felt that all adults should be tested for Lp(a) at least once in their lifetime.
However, support for targeted testing was much stronger. Roughly 70% of clinicians believed Lp(a) testing is warranted in high-risk populations, including:
- Patients with premature cardiovascular disease
- Individuals with a family history of premature ASCVD
- Patients experiencing recurrent cardiovascular events
These views are largely consistent with recommendations from leading professional bodies. The American Heart Association advises Lp(a) testing in individuals with a personal or family history of ASCVD and in women with hypercholesterolemia. Meanwhile, the National Lipid Association has gone further, suggesting that all adults should be tested at least once.
Yet, despite these recommendations, routine implementation has lagged.
Barriers to Lp(a) Testing
When asked why Lp(a) testing remains so uncommon, clinicians pointed to several interrelated barriers:
- Lack of clear management guidelines
Many clinicians expressed uncertainty about what specific actions to take when Lp(a) levels are elevated, especially in the absence of approved, targeted therapies. - Inconsistent or non-harmonized recommendations
Differences between professional guidelines on who should be tested contribute to confusion and inconsistent practice patterns. - Limited awareness beyond specialists
Although awareness is high among cardiologists, some clinicians—particularly in primary care—still feel insufficiently informed about the role of Lp(a) in ASCVD. - Absence of approved Lp(a)-lowering therapies
Perhaps the most significant barrier is therapeutic inertia. Without a clearly defined treatment pathway, many clinicians are hesitant to order a test that may not directly change management.
Future Therapies Could Change the Landscape
Despite current limitations, optimism remains high about the future of Lp(a)-targeting therapies. Several investigational agents are in development, and clinicians appear ready to adopt them—provided robust evidence is available.
In the survey, respondents emphasized that before prescribing any Lp(a)-lowering therapy, they would want to see:
- Strong cardiovascular outcomes data
- Long-term safety and efficacy results
If such criteria are met, adoption could be substantial. About 47% of clinicians said they would prescribe an Lp(a)-targeted therapy to patients with premature cardiovascular disease, while 51% would consider it for patients with recurrent cardiovascular events.
These responses suggest that once effective therapies become available, Lp(a) testing rates could rise rapidly, as clinicians would have clearer incentives and pathways for action.
Read about: GLP-1RAs Linked to Reduced Haemorrhagic Stroke Risk
Opportunities to Improve Testing Rates
The authors also noted that system-level interventions could help bridge the current gap. Tools such as electronic health record (EHR) reminders, especially in pre-procedure or high-risk settings, have already shown promise in increasing Lp(a) testing rates.
Education campaigns, clearer consensus guidelines, and integration of Lp(a) into standard cardiovascular risk algorithms may further normalize testing in routine practice.
Conclusion
The survey highlights a paradox at the heart of modern preventive cardiology: Lp(a) is widely recognized as an important cardiovascular risk factor, yet remains vastly under-tested. Clinicians understand its value, particularly in high-risk populations, but face practical barriers related to guidelines, therapeutic uncertainty, and system-level inertia.
As targeted therapies move closer to clinical reality, and as professional societies refine and align their recommendations, Lp(a) may finally take its place alongside cholesterol, blood pressure, and diabetes as a routine component of cardiovascular risk assessment. Until then, closing the gap between awareness and action remains a critical challenge—and opportunity—in cardiovascular prevention.
2 thoughts on “Despite High Awareness of Lp(a) as a Cardiovascular Risk Factor, Testing Rates Remain Alarmingly Low”