HMN 2025: What is the simple, cost-effective test that saves lives

Routine testing for a specific lipoprotein known as Lp(a) would be a cost-saving way to significantly reduce the risk of cardiovascular disease and save lives, according to an international research taskforce led by Monash University.

Elevated levels of Lp(a) impact an estimated 1 in 5 people worldwide and lead to an increased risk of cardiovascular disease, the number one cause of death globally. Despite this, levels of Lp(a) are not routinely measured in clinical practice and most people with elevated levels don’t know they’re at risk—something the researchers call a “public health blind spot.”

The study, published in Atherosclerosis, analyzed data from more than 10,000 adults in the U.K. The results were striking: routine Lp(a) testing would have reclassified 20% of participants as high-risk, leading to earlier intervention with blood pressure or cholesterol-lowering medications.

The research team designed a health economic model based on the population data, which showed that testing could prevent 60 heart attacks, 13 strokes and 26 early deaths (per 10,000 people tested) and lead to 169 years of life gained and 217 years of living in good health in Australia.

In 2020–21, an estimated 9.5% of total allocated expenditure in the Australian health system ($14.3 billion) was attributed to cardiovascular disease. The researchers also found Lp(a) testing would save approximately $85 in societal costs (health care plus productivity burden) per person in Australia.

Senior author, Health Economist, Head of the Health Economics and Policy Evaluation Research (HEPER) group at Monash’s Center for Medicine Use and Safety (CMUS) and core member of the Lp(a) International Taskforce, Professor Zanfina Ademi, said Lp(a) testing should be standard practice.

“Elevated Lp(a) is an inherited, lifelong, and independent risk factor for heart attacks, strokes, aortic stenosis, and premature cardiovascular events,” Professor Ademi said.

“Despite the risks, high Lp(a) remains dangerously underdiagnosed, with global testing prevalence reported to be exceedingly low. This significant oversight urgently demands international attention, which is why the FH Europe Foundation brought together an international taskforce to make Lp(a) testing routine and ensure equitable management across global populations.”

First author, Dr. Jed Morton, also from Monash University, said Lp(a) testing in Australia should be routine, and from a young age if it’s known to run in the family.

“There is solid evidence to show that Lp(a) can be a major risk factor for cardiovascular disease—the earlier people are tested, the better the chances are of intercepting the problem before it escalates. Now is the time to act,” Dr. Morton said.

These findings, which included data from other high-income countries as well as Australia, have contributed to The Brussels International Declaration on Lipoprotein(a) Testing and Management, announced in Glasgow earlier this year and also published in Atherosclerosis.