How frequently do you obtain lipoprotein (a) levels on asymptomatic patients without a prior history of CAD?

Recent recommendations are considering that the entire population ought to be tested at least once in their lifetime given the estimated prevalence in the general population of some degree of elevation in as many as 20% of the population.

That said I certainly check in most people with a family history of premature CAD.

The key is that there will likely be at least one medication coming to the market in the next few years based on some recently published trials that are promising for lowering the Lp(a).

This becomes more relevant as treatments that target lp(a) come out like the drug Eli Lilly is working on (lepidisiran). None are approved yet. The main aim for me has been driving LDL as low as possible and better understanding of how aggressive CAD patients with unimpressive LDL levels are having repeat events. I order it in circumstances where I think they might have some other factor involved, but not screening all my patients (although I would like to, insurance concerns not wanting patients responsible for large bills).

I find it useful to help guide how aggressively to treat a patient's underlying Lipid abnormalities. If patients understand that in addition to other classic risk profile abnormalities, they have a measurable hereditary "abnormality", they are more likely to accept aggressive lipid management. Despite their knowledge of an abnormal family history, many patients believe their healthy lifestyle will prevent future events (I explain that it will), but there is a belief "that it won't happen to me". With measurable data, such as an elevated Lp(a), they are more likely to accept the additional benefits (and protections) provided by statins and other lipid-lowering therapies and allow for an aggressive lowering of LDL and treatment of other risk ...

I tend to check a LP(a) level once when risk assessing patients who may not be accurately assessed by the traditional calculators, especially those who have multiple risk modifying factors (ethnicity, early FH, etc) to then have a more informed discussion about how aggressively to address their risk (start statin, motivate to exercise and lose weight, etc). I may even use it together with a Cor Calcium score if the score is low or 0. Having the additional information can be empowering for the motivated patients, and can help convince the patients on the fence that a more proactive strategy is indicated.

We have struggled to find consistency in insurance coverage for this. It's something I wish we could do more frequently since it's as easy as getting a Chem-7 done. That said, the typical new patient already presents with risk factors in this geographical region - including diabetes and/or CKD frequently.

For patients with a strong family history and a paucity (zero or one) of risk factors, we have had more success with coverage of coronary calcium scoring, its limitations with soft plaque notwithstanding. When patients see the scoring distribution by coronary artery, it tends to "hit home" if even one epicardial has an Agaston in the triple digits. They are more receptive to preventative pharmacotherapy and tend to pay more attention to "a...

Sung et al., PMID 40179012