Lipoprotein(a) and statin indications in low-risk patients based on the 2026 ACC/AHA dyslipidemia guideline
- 1Section of Cardiovascular Medicine, Department of Medicine, Yale School of Medicine, New Haven, CT, United States of America
- 2Center for Outcomes Research and Evaluation, Yale New Haven Health, New Haven, CT, United States of America
Abstract
Background: Though elevated lipoprotein (a) (Lp[a]) is associated with ASCVD and testing is recommended for all adults, how to use Lp(a) for decision-making in low-risk patients remains uncertain.
Methods: We studied low-risk adults in a large healthcare system, excluding those on statins or with statin indications in the 2026 ACC/AHA dyslipidemia guideline. ASCVD risk and statin eligibility were estimated using the PREVENT equations, incorporating Lp(a) using a calculation proposed by the AHA: ASCVD risk x (1.11^[(Lp[a] in nmol/L)/50]). Measured Lp(a) was used when available, and imputed values were used for all other adults.
Results: The cohort included 124 low-risk patients with measured Lp(a) (median [25th–75th percentile] age 44 [38–50] years; 64.5% women) and 28,527 without Lp(a) (median age 42 [36–49] years, 73.3% women). Adding Lp(a) to 10-year risk equations made 3.3% of patients with measured Lp(a) ≥125 nmol/L and 0.1% with imputed Lp(a) of 125 nmol/L newly statin eligible. Eligibility rose with older age, higher Lp(a), and higher ASCVD risk. When Lp(a) was added to 30-year risk in exploratory analyses, 20.2% with measured Lp(a) and 19.6% with imputed Lp(a) of 125 nmol/L met statin eligibility, and 70.0–84.6% (measured cohort) and 33.1–54.2% (imputed cohort) at the highest Lp(a) quintile met eligibility as age increased.
Conclusions: Integrating Lp(a) into ASCVD risk equations changes predicted risk and potential statin eligibility in low-risk adults not indicated for therapy under current guidelines. Including Lp(a) in risk estimation and clinical decision-making, particularly for patients with elevated levels, could be considered in patients with low ASCVD risk.
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BibTeX
@article{faridi2026lipoproteina,
title = {{Lipoprotein(a) and statin indications in low-risk patients based on the 2026 ACC/AHA dyslipidemia guideline}},
author = {Kamil F. Faridi and Qifan Wu and Erica S. Spatz and Nihar R. Desai and Yuan Lu},
journal = {American heart journal plus : cardiology research and practice},
year = {2026},
month = oct,
doi = {10.1016/j.ahjo.2026.100993},
url = {https://europepmc.org/article/PMC/PMC13722061},
note = {CC BY-NC-ND},
}
RIS
TY - JOUR
TI - Lipoprotein(a) and statin indications in low-risk patients based on the 2026 ACC/AHA dyslipidemia guideline
AU - Kamil F. Faridi
AU - Qifan Wu
AU - Erica S. Spatz
AU - Nihar R. Desai
AU - Yuan Lu
PY - 2026
DA - 2026/10/23
JO - American heart journal plus : cardiology research and practice
DO - 10.1016/j.ahjo.2026.100993
UR - https://europepmc.org/article/PMC/PMC13722061
AB - Background: Though elevated lipoprotein (a) (Lp[a]) is associated with ASCVD and testing is recommended for all adults, how to use Lp(a) for decision-making in low-risk patients remains uncertain. Methods: We studied low-risk adults in a large healthcare system, excluding those on statins or with statin indications in the 2026 ACC/AHA dyslipidemia guideline. ASCVD risk and statin eligibility were estimated using the PREVENT equations, incorporating Lp(a) using a calculation proposed by the AHA: ASCVD risk x (1.11^[(Lp[a] in nmol/L)/50]). Measured Lp(a) was used when available, and imputed values were used for all other adults. Results: The cohort included 124 low-risk patients with measured Lp(a) (median [25th–75th percentile] age 44 [38–50] years; 64.5% women) and 28,527 without Lp(a) (median age 42 [36–49] years, 73.3% women). Adding Lp(a) to 10-year risk equations made 3.3% of patients with measured Lp(a) ≥125 nmol/L and 0.1% with imputed Lp(a) of 125 nmol/L newly statin eligible. Eligibility rose with older age, higher Lp(a), and higher ASCVD risk. When Lp(a) was added to 30-year risk in exploratory analyses, 20.2% with measured Lp(a) and 19.6% with imputed Lp(a) of 125 nmol/L met statin eligibility, and 70.0–84.6% (measured cohort) and 33.1–54.2% (imputed cohort) at the highest Lp(a) quintile met eligibility as age increased. Conclusions: Integrating Lp(a) into ASCVD risk equations changes predicted risk and potential statin eligibility in low-risk adults not indicated for therapy under current guidelines. Including Lp(a) in risk estimation and clinical decision-making, particularly for patients with elevated levels, could be considered in patients with low ASCVD risk.
SN - 2666-6022
ER -