31st October 2025, A/Prof Chee L Khoo
We have covered the issue of lipoprotein (a) on a number of occasions in the past. We highlighted how the additional atherosclerotic harm in patients with elevated levels. Although lipoprotein (a) lowering agents are yet to hit the market, it is still important to check the levels at least once in all patients as the results may influence your LDL-C targets as well as prompt further cardiovascular investigations. Further, an elevated lp (a) level may prompt cascade screening for the patient’s extended family. I recently presented the results of an audit of my practice at the Australian Atherosclerosis Society (AAS) Annual Scientific Meeting. It was an oral abstract that I was privileged to be invited to present. Here is the abstract.
Prevalence of Elevated Lipoprotein(a) in Australian General Practice: A Retrospective Audit
Chee Leong Khoo1,2, Melissa Leung3, James Sindone4, Robert Hungerford5
1healthfocus family practice, Sydney, Australia. 2Diabetes, Obesity and Metabolic Translational Unit, Sydney, Australia. 3Dept of Cardiology, Ingham Institute at Liverpool Hospital, University of NSW, Sydney, Australia. 43Department of Cardiology, Royal Prince Alfred Hospital, Sydney, Australia. 5School of Medicine, University of Newcastle, Newcastle, Australia
Title
Prevalence of Elevated Lipoprotein(a) in Australian General Practice: A Retrospective Audit
Abstract
Background: Lipoprotein(a) [Lp(a)] is an independent cardiovascular risk factor, with elevated levels present in up to 20% of populations worldwide. The prevalence of elevated Lp(a) [eLp(a)] in Australian primary care, and its relationship with atherosclerotic cardiovascular disease (ASCVD), has not been well described. Understanding this may inform risk stratification and management.
Methods: We conducted a retrospective audit of patients from a Sydney general practice who underwent Lp(a) testing between November 2022 and May 2025. The primary outcome was prevalence of eLp(a) (>50mg/dl or >100 nmol/L). Secondary outcomes included prevalence of established or newly identified ASCVD, referral pathways, and initiation/intensification of lipid-lowering therapy (LLT).
Results: Among 562 patients tested, 23% had eLp(a). Of these, 86% had no prior ASCVD. In patients with eLp(a) and no known ASCVD, 17% were subsequently found to have ASCVD (4% obstructive (≥ 70%), 13% non-obstructive) on further imaging. High-risk patients (cardiovascular risk >10%) and those with coronary calcium scores >100 were referred to cardiology. LLT was initiated or intensified in 52% of eLp(a) patients. Family cascade testing was recommended for 69% of patients with eLp(a). Among patients with eLp(a) and known ASCVD (14%), LLT was intensified in all cases.
Conclusion: In this Australian primary care cohort, the prevalence of eLp(a) was higher than global estimates. Elevated Lp(a) was associated with previously unrecognised ASCVD and commonly prompted treatment escalation and cascade testing, supporting its role in refining cardiovascular risk assessment in primary care.
Essentially, what the audit demonstrated that up to 23% of our patients may have elevated Lp(a). 109 out of the 127 patients with elevated Lp(a) were not known to have ASCVD. Because of the elevated Lp(a), further investigations in these patients uncovered ASCVD in 18 patients. 4 of these patients had obstructive stenosis (>70%) requiring intervention while 14 had non-obstructive stenosis which led to intensification or initiation of lipid-lowering therapy.
How many of your patients have elevated Lp(a) which may proceed to an acute event? I managed to prevent at least 4 and potentially another 14.
Have you have your Lp(a) checked yet?