Aug. 20, 2025 — A major international study published in Atherosclerosis* has found that routinely testing for lipoprotein(a) [Lp(a)], a largely overlooked genetic marker for cardiovascular risk, could significantly enhance early detection of heart disease and reduce long-term healthcare costs.
Led by researchers at Monash University (Melbourne, Australia), the study underscores a crucial gap in current clinical practice: although elevated Lp(a) levels are a lifelong, inherited risk factor for atherosclerotic cardiovascular disease (ASCVD), they are rarely measured in routine care. As a result, millions of individuals at elevated risk go unidentified, even when other cholesterol and lifestyle indicators appear within normal ranges.
“Lp(a) is one of the most important cardiovascular risk markers we’re not routinely testing for,” said Professor Zanfina Ademi, health economist and senior author of the study. “We’re missing a key opportunity to identify high-risk patients early and intervene before serious events like heart attacks or strokes occur.”
Analyzing data from 10,000 individuals in the UK Biobank, the research team found>that incorporating Lp(a) into cardiovascular risk assessment would reclassify around 20% of people into a higher-risk category. This shift would enable earlier lifestyle interventions and targeted use of widely available preventive therapies, such as statins and blood pressure medications, even before Lp(a)-specific treatments become available.
In the same issue, Prof. Jan Boren, Editor-in-Chief of Atherosclerosis, issues a call to action in an editorial**, urging guideline developers and policymakers to act: “When a simple blood test can help prevent life-threatening cardiovascular events and improve quality of life, all in a cost-effective way, implementing such testing isn't just advisable, it's imperative”.
The modeling suggests that Lp(a) testing could prevent 60 heart attacks, 13 strokes and 26 premature deaths per 10,000 people screened, while generating an estimated AU$85 and £263 in net savings per person respectively in Australia and in the UK, thanks to reduced hospitalizations and productivity losses, and improved health outcomes.
To assess the broader applicability of this approach, the researchers also conducted parallel cost-adaptation analyses across nine other high-income nations. The results were consistent: from the United States and Canada to Germany, Austria and France, routine Lp(a) testing was projected to be cost saving in every national health system evaluated. Despite this strong economic and clinical rationale, Lp(a) testing remains rarely used in practice. The findings lend urgent support to the Brussels International Declaration on Lp(a) Testing and Management, a 2025 global policy initiative urging governments to incorporate Lp(a) into national cardiovascular screening programs and develop clinical care pathways for those with elevated levels.
“This is a one-time, inexpensive test with lifelong relevance,” said Professor Florian Kronenberg, co-author and cardiovascular genetics expert from the Medical University of Innsbruck. “We are missing an enormous preventive opportunity in everyday clinical care.”
Although elevated Lp(a) affects more than 1.4 billion people worldwide, awareness remains low — not just among the public, but among healthcare professionals. Many clinicians are unaware that Lp(a) levels are primarily genetically determined and cannot be improved through lifestyle modification alone. Testing is the only way to identify those at increased risk.
“We now have the clinical evidence, the health economic backing, and the international policy consensus,” said Magdalena Daccord, CEO of FH Europe Foundation and co-author of the study. “What we lack is implementation. Routine Lp(a) testing must become standard practice, not tomorrow, but today. We trust this study will be the final prove to ensure Lp(a) testing is included in the Cardiovascular Health Plan for Europe, as well as nationally alongside FH early screening”
With cardiovascular disease still the world’s leading cause of death, costing more than €282 billion annually in Europe, the authors argue that integrating Lp(a) screening represents a simple, evidence-based action that could have a profound impact on public health with the further positive effect of cost-saving, an important issues especially in times of great cost pressure.
Commissioned by the Lp(a) International Taskforce and hosted by the FH Europe Foundation (FHEF), this patient-driven research initiative was led by the Centre for Medicine Use and Safety at the Monash Institute of Pharmaceutical Sciences, in collaboration with global researchers and the Lp(a) International Taskforce. The study forms part of a broader multistakeholder effort to advance understanding and action on Lp(a).
References:
* Lp(a) testing for the primary prevention of cardiovascular disease in high-income countries: a cost-effectiveness analysis.
November 12, 2025 
