LP(a) screening may help detect inherited heart disease risk

Evening Anchor

PITTSBURGH —

A simple blood test for lipoprotein(a), or LP(a), could help identify a major hidden risk for heart attacks and strokes, but many people remain unaware of it, and routine screenings are not yet widespread.

In 2019, Shep Joseph of Pennsylvania experienced what he thought was a minor health issue.

“I always say I really didn’t have a big event. I had an event where I was just kind of a little bit tired more than usual, a little shorter of breath,” Joseph said.

When he sought medical attention, doctors discovered Joseph needed immediate surgery.

“They took a stress test and failed that. And they quickly did a cardiac cath on me and determined I needed bypass surgery, like, immediately,” Joseph said.

Joseph, who was 54 at the time, had undergone routine physicals, bloodwork, and cholesterol checks. However, no one had ever tested him for LP(a), an inherited cholesterol particle that can increase plaque buildup and the risk of heart attacks and strokes.

“She said, ‘We’re going to test your LP(a).’ And I had no idea what that was,” Joseph said.

Dr. Indu Poornima, director of clinical cardiology and imaging and preventive cardiology at Allegheny Health Network, explained the significance of LP(a).

“It’s both atherogenic as well as thrombogenic, which is basically the two components that lead to a heart attack or stroke, so lipoprotein or LP(a) is a risk factor for heart attacks as well as for strokes,” Poornima said.

LP(a) is not included in standard cholesterol panels, which contributes to the lack of awareness.

“It’s something that has to be ordered independently of a standard lipid panel,” Poornima said.

Approximately 20 to 25% of people are believed to have elevated LP(a), which is almost entirely inherited and remains relatively stable throughout a person’s life.

“Just earlier this year, the 2026 American College of Cardiology American Heart Association guidelines on primary and secondary prevention basically said that everybody should get a lipoprotein(a) level checked once in their lifetime, at least. So until it became part of the guidelines, it was not mainstream. But I think now it will be,” Poornima said.

However, insurance coverage for the test varies. The trade group representing America’s health insurance plans, AHIP, stated, “It is the determination of each individual plan to cover this test and under which circumstances. We have not taken a formal position on the bill.”

UnitedHealthcare said its policy is under review, while Aetna has updated its policy to cover LP(a) screening in line with the new guidelines. UPMC Health Plan will cover one lifetime LP(a) test for members 18 and older with applicable cost-sharing.

For those without insurance coverage, Labcorp and Quest Diagnostics offer the test for about $50 without a prescription. Quest Diagnostics reported increased demand for the test since the guidelines changed, noting that close to 30% of people tested have abnormal LP(a) levels.

For patients like Joseph, knowing their LP(a) number can influence their care.

“She wanted my cholesterol numbers to be extremely low, lower than the standard normal person would be, just as an additional preventative measure,” Joseph said.

While there is no approved drug to lower LP(a) yet, doctors emphasize that controlling LDL cholesterol and other risk factors can reduce the impact of elevated LP(a).

“If you control those other risk factors really well, including keeping your LDL levels below 70, sometimes ideally below 55, the likelihood that the LP(a) is going to have an impact is definitely lowered,” Poornima said.

For Hyvelle Ferguson Davis, CEO and founder of the nonprofit Heart Sisters, the importance of LP(a) testing became clear after years of devastating cardiac events.

“One person does not have to go through what I’ve been through — one heart attack, a stroke, quadruple bypass and 11 stents inside of me. No. This all could have been mitigated with one simple test,” Davis said.

Davis and her colleague Roseline Moise are advocating for a bill that would require insurance coverage for LP(a) testing.

“So we have a lot of stakeholders who are supporting us, who are actively working with us within the organization to ensure that H.R. 8260 gets to the finish line, because it’s all about saving lives,” Moise said.

They argue that too many people are unaware of this inherited risk.

“I like to say, a ticking time bomb, without even realizing that they have that,” Moise said.

There is new urgency as drugs designed specifically to lower LP(a) are now in phase three clinical trials.

“All of these drugs lower LP(a) by close to 90%, which is quite amazing,” Poornima said.

Doctors and patients who learned about this risk too late urge people to ask about their LP(a) number.

“You just have to take it once, and at least you’ll either know you have it or you don’t, and then you can empower yourself to do something about it,” Joseph said.