Lp(a) testing and treatment with Lp(a)-lowering therapies in the primary and secondary prevention of cardiovascular disease in high income countries: A preliminary health technology assessment.

Atherosclerosis · July 2026 · Jedidiah I Morton, Florian Kronenberg, Raul D Santos, Albert Wiegman, Iñaki Gutiérrez Ibarluzea, et al.

What this study found

BACKGROUND AND AIMS: New therapies targeting Lipoprotein(a) (Lp(a)) are anticipated to enter clinical practice soon. We aimed to estimate the benefits of Lp(a) lowering therapy and threshold price at which treatment with Lp(a)-lowering therapies for people with high Lp(a) in high-risk primary or secondary prevention would be cost-effective from a healthcare and societal perspective using genetic and epidemiological data in the absence of phase III cardiovascular outcome trials.

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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.

Primary 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

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.

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