Evidence mapPaperPMID 41848055Full record

ArticleJournal of the American Heart Association2026

Association Between Lipoprotein(a) Testing, Lipid-Lowering Therapy Intensification, and Low-Density Lipoprotein Cholesterol Goal Attainment: Findings From the Veterans Affairs Health System.

Shyon Parsa, Priyansh Shah, Adam Furst, Ramzi Dudum, Natasha Din, David Maron, Paul Heidenreich, Jonathan H Ward, Anthony Lozama, Alexander T Sandhu and 1 more

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Article in Journal of the American Heart Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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5 · Who and what money

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11 authors.

Shyon ParsaDepartment of Medicine Stanford University Hospital Stanford CA.ORCID 0000-0002-3909-154X
Priyansh ShahDepartment of Internal Medicine Jacobi Hospital/Albert Einstein College of Medicine New York NY.ORCID 0000-0003-0051-6595
Adam FurstDivision of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford CA.
Ramzi DudumDivision of Cardiovascular Medicine University of California San Francisco San Francisco CA.ORCID 0000-0002-8629-2870
Natasha DinVeterans Affairs Palo Alto Health Care System Palo Alto CA.ORCID 0000-0001-5312-4451
David MaronDivision of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford CA.ORCID 0000-0002-4867-8588
Paul HeidenreichDivision of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford CA.ORCID 0000-0001-7730-8490
Jonathan H WardNovartis Pharmaceuticals Corporation East Hanover NJ.ORCID 0009-0002-6739-6567
Anthony LozamaNovartis Pharmaceuticals Corporation East Hanover NJ.
Alexander T SandhuDivision of Cardiovascular Medicine and Cardiovascular Institute Stanford University School of Medicine Stanford CA.ORCID 0000-0003-3208-1143
Fatima RodriguezDepartment of Medicine Stanford University Hospital Stanford CA.ORCID 0000-0002-5226-0723

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundLipoprotein(a) (Lp[a]) can refine atherosclerotic cardiovascular disease risk assessment and guide lipid-lowering therapy intensification (LLTI). However, the association between Lp(a) testing and LLTI across large health systems is not well characterized.

methodsUsing Veterans Affairs electronic health record data, we conducted a retrospective cohort study of veterans undergoing lipid testing from January 1, 2017, to June 30, 2024. We first compared a 1:1 propensity-matched cohort with concurrent low-density lipoprotein cholesterol (LDL-C) and Lp(a) testing with those with LDL-C testing alone. We then compared veterans with elevated versus nonelevated Lp(a) (>50 versus <50 mg/dL). The primary outcome was LLTI within 12 months, defined as therapy initiation, dose escalation, or addition of another lipid-lowering agent. LDL-C goal attainment (<100 mg/dL primary prevention; <70 mg/dL secondary prevention) was assessed within 12 months. Multivariable logistic regression adjusted for sociodemographic and clinical factors.

resultsAmong 6 941 840 veterans with LDL-C testing, 10 384 (0.1%) underwent Lp(a) testing. The propensity-matched cohort included 20 768 veterans (mean±SD age, 58.4±15.3 years; 12.4% women; 19.2% Black individuals). Elevated Lp(a) (>50 mg/dL) was present in 25% (n=2562). Lp(a) testing was associated with greater LLTI (odds ratio [OR], 2.11 [95% CI, 1.95-2.29]), LDL-C testing (OR, 1.27 [95% CI, 1.19-1.36]), and LDL-C goal attainment (OR, 1.22 [95% CI, 1.12-1.33]). Compared with Lp(a) <50 mg/dL, Lp(a) >50 mg/dL was associated with increased LLTI (OR, 1.73 [95% CI, 1.55-1.94]). Lp(a) >100 mg/dL was associated with lower LDL-C goal attainment (OR, 0.68 [95% CI, 0.56-0.84]).

conclusionsLp(a) testing was associated with increased LLTI and LDL-C goal attainment. Elevated Lp(a) identified individuals more likely to undergo LLTI, suggesting testing may motivate preventive treatment optimization.

Indexed as

Cardiovascular DiseasesCholesterol, LDLDyslipidemiasHypolipidemic AgentsLipoprotein(a)AgedBiomarkersFemaleHumansMaleMiddle AgedRetrospective StudiesRisk AssessmentSecondary PreventionUnited StatesUnited States Department of Veterans AffairsBiomarkersCholesterol, LDLHypolipidemic AgentsLipoprotein(a)LPA protein, humanatherosclerotic cardiovascular diseaseguideline‐directed lipid goal attainmentlipid‐lowering therapylipoprotein(a)low‐density lipoprotein cholesterol

Identifiers

PMID41848055
PMCPMC13279102

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.