It’s time to test all adults for lipoprotein(a)

Abstract

The recent 2026 American College of Cardiology/American Heart Association Multisociety Guideline on the Management of Dyslipidemia joins the growing international consensus that lipoprotein(a) [Lp(a)] should be tested at least once in all adults. Despite the estimation that approximately 1 in 5 individuals have Lp(a) levels at or above those that are clearly associated with an increased risk for atherosclerotic cardiovascular disease and calcific aortic valve stenosis (≥50 mg/dL or ≥125 nmol/L), data from recent studies reveal very low testing rates across the general population. Thus, expanded Lp(a) testing is urgently needed. Along with guidance to test all adults for Lp(a), solutions are needed to help address remaining knowledge gaps, barriers to testing, and nuances in the clinical use of Lp(a). Studies designed to address these unmet needs should be prioritized as we enter the era of universal Lp(a) testing in adults.