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Optimizing lipoprotein(a) testing for immediate clinical impact in primary prevention

Björnson, Elias ; Hagström, Emil ; Littmann, Karin ; Östgren, Carl Johan ; Söderberg, Stefan ; Engström, Gunnar LU ; Hogling, Daniel Eriksson ; Bergström, Göran and Brinck, Jonas (2026) In Atherosclerosis 419.
Abstract

Background and aims Guidelines recommend measuring lipoprotein(a) [Lp(a)] at least once in all adults, but testing remains limited in clinical practice. We evaluated pragmatic strategies to maximize the immediate clinical impact of Lp(a) testing on the need of lipid-lowering treatment (LLT) in a primary prevention setting. Methods In 24,994 individuals aged 50–65 years from the population-based Swedish Cardiopulmonary BioImage Study (SCAPIS), we assessed: (i) whether self-reported data can identify individuals likely to have elevated Lp(a) (≥50 mg/dL) and thus serve as a pre-screening tool, and (ii) how the clinical impact of Lp(a) testing—defined as eligibility for LLT according to ESC/EAS guidelines—varies by age and sex. Results... (More)

Background and aims Guidelines recommend measuring lipoprotein(a) [Lp(a)] at least once in all adults, but testing remains limited in clinical practice. We evaluated pragmatic strategies to maximize the immediate clinical impact of Lp(a) testing on the need of lipid-lowering treatment (LLT) in a primary prevention setting. Methods In 24,994 individuals aged 50–65 years from the population-based Swedish Cardiopulmonary BioImage Study (SCAPIS), we assessed: (i) whether self-reported data can identify individuals likely to have elevated Lp(a) (≥50 mg/dL) and thus serve as a pre-screening tool, and (ii) how the clinical impact of Lp(a) testing—defined as eligibility for LLT according to ESC/EAS guidelines—varies by age and sex. Results Self-reported data poorly predicted elevated Lp(a) (ROC-AUC 0.54). Overall, incorporating Lp(a) levels increased eligibility for LLT from 11.3% to 19.6%. However, the clinical impact varied by age and sex. The number needed to screen (NNS) to identify one additional individual eligible for LLT was lowest in men aged 50–60 years (≈10–15) and women ≥55 years (<20 at age 55 and < 10 at age 65), but substantially higher in younger women (NNS >50). Conclusions Elevated Lp(a) cannot be reliably identified using self-reported data. Incorporation of Lp(a) levels substantially increased eligibility for LLT. Targeting testing in men ≥50 years and women ≥55 years maximizes immediate clinical utility and may serve as a pragmatic interim strategy pending broader implementation of universal Lp(a) testing.

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type
Contribution to journal
publication status
published
subject
in
Atherosclerosis
volume
419
article number
120826
publisher
Elsevier
external identifiers
  • scopus:105042623391
  • pmid:42341483
ISSN
0021-9150
DOI
10.1016/j.atherosclerosis.2026.120826
language
English
LU publication?
yes
id
2d413573-1d32-46f6-8073-efbe15ceed9c
date added to LUP
2026-08-24 09:00:49
date last changed
2026-08-24 09:01:36
@article{2d413573-1d32-46f6-8073-efbe15ceed9c,
  abstract     = {{<p>Background and aims Guidelines recommend measuring lipoprotein(a) [Lp(a)] at least once in all adults, but testing remains limited in clinical practice. We evaluated pragmatic strategies to maximize the immediate clinical impact of Lp(a) testing on the need of lipid-lowering treatment (LLT) in a primary prevention setting. Methods In 24,994 individuals aged 50–65 years from the population-based Swedish Cardiopulmonary BioImage Study (SCAPIS), we assessed: (i) whether self-reported data can identify individuals likely to have elevated Lp(a) (≥50 mg/dL) and thus serve as a pre-screening tool, and (ii) how the clinical impact of Lp(a) testing—defined as eligibility for LLT according to ESC/EAS guidelines—varies by age and sex. Results Self-reported data poorly predicted elevated Lp(a) (ROC-AUC 0.54). Overall, incorporating Lp(a) levels increased eligibility for LLT from 11.3% to 19.6%. However, the clinical impact varied by age and sex. The number needed to screen (NNS) to identify one additional individual eligible for LLT was lowest in men aged 50–60 years (≈10–15) and women ≥55 years (&lt;20 at age 55 and &lt; 10 at age 65), but substantially higher in younger women (NNS &gt;50). Conclusions Elevated Lp(a) cannot be reliably identified using self-reported data. Incorporation of Lp(a) levels substantially increased eligibility for LLT. Targeting testing in men ≥50 years and women ≥55 years maximizes immediate clinical utility and may serve as a pragmatic interim strategy pending broader implementation of universal Lp(a) testing.</p>}},
  author       = {{Björnson, Elias and Hagström, Emil and Littmann, Karin and Östgren, Carl Johan and Söderberg, Stefan and Engström, Gunnar and Hogling, Daniel Eriksson and Bergström, Göran and Brinck, Jonas}},
  issn         = {{0021-9150}},
  language     = {{eng}},
  publisher    = {{Elsevier}},
  series       = {{Atherosclerosis}},
  title        = {{Optimizing lipoprotein(a) testing for immediate clinical impact in primary prevention}},
  url          = {{http://dx.doi.org/10.1016/j.atherosclerosis.2026.120826}},
  doi          = {{10.1016/j.atherosclerosis.2026.120826}},
  volume       = {{419}},
  year         = {{2026}},
}