The cardiovascular blindspot exposed by a simple blood test

There is mounting evidence that elevated lipoprotein(a) [Lp(a)] is a strong, independent, and causal risk factor for cardiovascular disease. Yet, despite affecting one in five individuals, Lp(a) testing rates remain alarmingly low (1% to 2%) – a gap researchers are calling a “public health blindspot.”

An international taskforce led by Monash University has revealed that routine Lp(a) testing could dramatically shift clinical practice and deliver significant cost savings. Analysing data from more than 10,000 adults, the researchers found that 20% of participants would have been reclassified as high-risk, prompting earlier intervention with cholesterol- or blood pressure-lowering medications.

“Elevated Lp(a) is an inherited, lifelong, and independent risk factor for heart attacks, strokes, aortic stenosis, and premature cardiovascular events,” said Professor Zanfina Ademi, senior author, health economist, and Head of the Health Economics and Policy Evaluation Research (HEPER) group at Monash’s Centre for Medicine Use and Safety (CMUS).

“Despite the risks, high Lp(a) remains dangerously underdiagnosed, with global testing prevalence reported to be exceedingly low. This significant oversight urgently demands international attention, which is why the FH Europe Foundation brought together an international taskforce to make Lp(a) testing routine and ensure equitable management across global populations.”

Cardiovascular disease accounts for 9.5% of Australia’s total health expenditure, or $14.3 billion annually. Researchers argue that routine testing could play a crucial role in curbing this burden.

Despite growing evidence, routine testing remains contentious. The 2023 Australian Atherosclerosis Society Position Statement on Lipoprotein(a) recommended selective screening of high-risk patients, but not universal population testing. In 2022, the Royal College of Pathologists of Australasia (RCPA) submitted an MSAC application for public funding of Lp(a) testing, which was supported by Pathology Technology Australia (PTA) and the Heart Foundation, but not by the Royal Australian College of General Practitioners (RACGP).

While no therapies currently target Lp(a) specifically, existing treatments are showing promise. Novartis’ first-in-class siRNA cholesterol-lowering therapy, Leqvio (inclisiran), listed on the Pharmaceutical Benefits Scheme (PBS) last year, reduces LDL-C by around 50% and has also been shown to cut Lp(a) levels by 15% to 25%.

The health economic model from the Lp(a) International Taskforce’s study suggested substantial benefits: in Australia alone, Lp(a) testing could prevent 60 heart attacks, 13 strokes, and 26 premature deaths per 10,000 people tested. It would also generate an estimated 169 years of life gained and 217 years of healthy life years, while saving $85 per person in societal costs when healthcare and productivity impacts are combined.

First author Dr Jed Morton, also from Monash University, emphasised the urgency of earlier detection.
“There is solid evidence to show that Lp(a) can be a major risk factor for cardiovascular disease – the earlier people are tested, the better the chances are of intercepting the problem before it escalates. Now is the time to act,” Dr Morton said.

These latest findings add weight to the Brussels International Declaration on Lipoprotein(a) Testing and Management, which calls for global action to integrate Lp(a) into routine cardiovascular risk assessments.

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