Lipoprotein(a), commonly known as Lp(a), is emerging as a critical yet often overlooked biomarker in cardiovascular disease management. This genetically determined lipid particle affects approximately one in five adults and has been linked to a range of cardiovascular conditions through numerous epidemiological studies.
"Lp(a) is a lipid particle, like an LDL particle that has received an incredible amount of attention lately," explains Nathan Wong, PhD, FACC, FAHA, FNLA, director of the University of California (UC) Irvine Heart Disease Prevention Program. "Numerous epidemiologic Mendelian randomization and genome-wide association studies have shown it to be linked to atherosclerotic cardiovascular disease events, as well as aortic stenosis, and even other cardiovascular conditions such as heart failure and atrial fibrillation."
Clinical Significance of Early Lp(a) Detection
The value of early identification of cardiovascular risk factors extends beyond individual patient care to healthcare resource utilization. Jeremy Wigginton, MD, MBA, FAAFP, health plan chief medical officer and physician executive from Harrisburg, PA, emphasizes this point: "The earlier identification of both the risk factors for cardiovascular disease or the existence of that disease is a major factor in being able to effectively treat that condition, treat that disease, prevent the advancement of the disease, prevent the development of additional comorbidities of that disease, and also to improve the quality of life for patients."
Cardiovascular disease consistently ranks among the top three conditions driving healthcare utilization and costs nationwide, alongside cancer and musculoskeletal conditions. This economic burden underscores the importance of preventive strategies and early detection.
Insurance Coverage and Testing Recommendations
Despite its clinical importance, Lp(a) testing faces some coverage challenges. While generally well-covered by insurance, including Medicare, it differs from traditional lipid panels in one key aspect.
"The difference between Lp(a) and the traditional lipid panel is that the traditional lipid panel is usually considered a preventative service, and so it is often covered at what we call 'first dollar' or at no cost to the patient or member," Wigginton explains. "Lp(a), however, is not today considered to be one of those core preventative services."
This distinction means patients on commercial health plans may face cost-sharing in the form of copays or coinsurance. Additionally, health plans with lab benefit managers might impose limitations on testing frequency, though current literature suggests Lp(a) testing may only need to be performed once in a lifetime for most patients.
Implementation in Clinical Practice
Healthcare systems are beginning to incorporate Lp(a) awareness into their electronic health record (EHR) systems. At UC Irvine, Wong and his team developed a best practice advisory for Lp(a) measurement that alerts physicians when patients meet specific criteria:
- Diagnosed atherosclerotic cardiovascular disease
- Familial hypercholesterolemia
- Aortic stenosis
- LDL cholesterol of 190 mg/dL or higher
- Family history of atherosclerotic cardiovascular disease
When these alerts appear, physicians receive recommendations to measure Lp(a) and are informed that more intensive risk factor management is recommended for patients with levels at or above 50 mg/dL or 125 nmol/L.
Similar alerts for other cardiovascular risk factors have shown promising results. Wong notes that a previous alert system for patients with LDL cholesterol of 190 mg/dL or higher resulted in approximately 50% higher rates of statin initiation, dramatic reductions in LDL cholesterol (around 80 points), and increased diagnosis of familial hypercholesterolemia.
Future Directions
As awareness of Lp(a) as a cardiovascular risk factor grows, healthcare systems will likely continue developing strategies to incorporate testing and management into routine care. The upcoming Lp(a) Awareness Day on March 24 aims to further educate both the public and medical community about this important risk marker.
With approximately 20% of adults affected by elevated Lp(a) levels, increased awareness and testing could significantly impact cardiovascular disease prevention and management strategies. As Wong emphasizes, "It's very important that the public, as well as the medical community, be aware of its significance as a risk driver for these conditions."
The integration of Lp(a) testing into clinical practice represents an important step toward more comprehensive cardiovascular risk assessment and personalized prevention strategies, potentially improving outcomes for millions of patients at risk for heart disease and related conditions.
