Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis.

Atherosclerosis · October 2025 · Jedidiah I Morton, Florian Kronenberg, Magdalena Daccord, Nicola Bedlington, Marius Geanta, et al.

What this study found

BACKGROUND AND AIMS: Cost-effectiveness of Lipoprotein(a) [Lp(a)] testing is not established. We aimed to evaluate the cost-effectiveness of Lp(a) testing in the cardiovascular disease (CVD) primary prevention population from healthcare and societal perspectives.

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How RAGMD uses this study

Clinical questions this paper informs

Synthesis lives on the evidence question — this page shows where the study sits in that analysis.

Core study

Does elevated lipoprotein(a) independently increase cardiovascular risk?

Mendelian randomization and epidemiologic data support Lp(a) as a causal cardiovascular risk factor. Specific Lp(a)-lowering therapies are emerging but routine treatment beyond standard risk factor control awaits outcome trial confirmation.

Open evidence analysis

Supporting literature

Is ApoB more useful than LDL-C for cardiovascular risk prediction?

Prospective cohorts and meta-analyses suggest ApoB may capture atherogenic particle burden better than LDL-C alone, particularly when triglycerides are elevated or LDL particles are discordant with LDL-C.

Open evidence analysis

Supporting literature

Should adults take statins for primary cardiovascular prevention?

Meta-analyses of primary prevention trials show reduced major adverse cardiovascular events with statins in appropriately selected moderate-to-high-risk adults. Shared decision-making should weigh absolute risk reduction against side effects and patient preference.

Open evidence analysis

Supporting literature

Do therapies that raise HDL reduce cardiovascular events?

Trials of niacin and CETP inhibitors raised HDL without consistent reduction in cardiovascular events when added to statins, challenging the hypothesis that raising HDL alone is protective.

Open evidence analysis

Supporting literature

Should coronary artery calcium scoring guide statin decisions?

Coronary artery calcium can reclassify intermediate-risk patients and inform statin initiation when risk is uncertain. A score of zero may support deferring therapy in selected low-risk individuals with shared decision-making.

Open evidence analysis

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