Lipoprotein(a) cascade screening in coronary artery disease

Q: What are the key findings of this study?

Cascade screening initiated from CAD patients with elevated Lp(a) identified elevated Lp(a) in 30.2% of first-degree relatives, compared to 6.2% when initiated from patients with low Lp(a) (P<0.001).

Q: What is the clinical evidence from this study?

Study design: Observational. Population: Coronary artery disease (n=1499). Intervention: Cascade screening from index patients with elevated Lp(a) (≥170 nmol/L) vs. Cascade screening from index patients with low Lp(a) (<70 nmol/L). Primary outcome: Elevated Lp(a) in first-degree relatives (NNT 3.3, 95% CI 2.7-4.2, p=<0.001).

Q: What question did this study set out to answer?

To determine the real-world feasibility and diagnostic effectiveness of cascade screening for elevated lipoprotein(a) among relatives of patients with coronary artery disease.

Karin Littmann; Daniel Eriksson Hogling; Mustafa Suhel; Kamilla Juhlin; Pinar Kara; Matteo Bottai; Niclas Svedberg; Anna M. Nordenskjöld; Mattias Ekström; Linda Mellbin; Per Grimfjärd; David Erlinge; Emil Hagström; Jonas Brinck

doi:10.1016/j.atherosclerosis.2026.120759

April 1, 2026AtherosclerosisOpen Access

Lipoprotein(a) cascade screening in coronary artery disease

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Key result

Targeted cascade screening yields elevated Lp(a) in ~30% of first-degree relatives of CAD patients.

NNT 3.3
95% CI 2.7-4.2
P<0.001
NNT 3.3
n=1,499

Why the study?

Elevated lipoprotein(a) contributes to coronary artery disease, but the effectiveness of cascade screening for elevated Lp(a) in relatives of CAD patients was unclear.

Does cascade screening initiated from CAD patients with elevated Lp(a) improve the identification of relatives with elevated Lp(a) compared to screening from patients with low Lp(a)?

Key Points

To determine the real-world feasibility and diagnostic effectiveness of cascade screening for elevated lipoprotein(a) among relatives of patients with coronary artery disease.
Conducted cascade screening in 764 first- and second-degree relatives (68.2% participation rate of 1,120 invited) of 735 index patients with coronary artery disease (mean age 66.5 years, 76.9% male).
Stratified index patients by lipoprotein(a) concentration into low (<70 nmol/L, n=333), moderately elevated (70-169 nmol/L, n=149), and elevated (≥170 nmol/L, n=253) cohorts to compare relative screening yields.
Elevated lipoprotein(a) was detected in 30.2% of first-degree and 19.4% of second-degree relatives of index patients with elevated levels, compared with 6.2% (p < 0.001) and 5.6% (p = 0.007) of relatives of index patients with low levels.
The number needed to screen to identify one relative with elevated lipoprotein(a) was 3.3 (95% CI, 2.7-4.2) versus 16.1 (95% CI, 10.0-30.8; p < 0.001) for first-degree relatives, and 5.1 (95% CI, 3.4-8.8) versus 17.8 (95% CI, 9.3-45.2; p = 0.006) for second-degree relatives in elevated versus low index groups.

Study Design

Type

Observational (n=1,499)

Structured PICO

Does cascade screening initiated from CAD patients with elevated Lp(a) improve the identification of relatives with elevated Lp(a) compared to screening from patients with low Lp(a)?

P

Population

735 index patients with coronary artery disease (mean age 66.5 years, 23.1% female) and 764 of their first- and second-degree relatives undergoing cascade screening for elevated Lipoprotein(a).

E

Exposure

Cascade screening for elevated Lp(a) initiated from index patients with elevated Lp(a) (≥170 nmol/L) or moderately elevated Lp(a) (70-169 nmol/L).

C

Comparator

Cascade screening initiated from index patients with low Lp(a) (<70 nmol/L).

O

Outcome

Proportion of elevated Lp(a) in relatives and number needed to screen to identify one individual with elevated Lp(a).surrogate

Main Result

Number Needed to Treat: 3.3 (95% CI 2.7–4.2)

Absolute Event Rate: 30.2% vs 6.2%

Number Needed to Treat: 3.3

p-value: p=<0.001

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Answers are grounded in this paper and cite their sources.

Implication

Cascade screening for elevated Lp(a) is highly effective when initiated from CAD patients with elevated Lp(a), requiring only 3.3 first-degree relatives to be screened to identify one affected individual.

Abstract

BACKGROUND AND AIM: Elevated lipoprotein(a) [Lp(a)] contributes to coronary artery disease (CAD). This study aimed to determine the effectiveness of cascade screening for elevated Lp(a) in patients with CAD. METHODS: Lp(a)-based cascade screening in first-degree relatives (FDR) and second-degree relatives (SDR) of index patients with CAD was performed. Index patients were recruited into pre-defined Lp(a) strata: low (<70 nmol/L), moderately elevated (70-169 nmol/L), and elevated (≥170 nmol/L). Proportions of elevated Lp(a) in relatives were determined within each index stratum, and participation rate was evaluated. RESULTS: 735 index patients (mean age 66.5 years, 76.9% male) participated, with 333, 149, and 253 in the low, moderately elevated, and elevated Lp(a) strata, respectively. Of 1120 invited relatives, 764 relatives (68.2%) were screened. Lp(a) was elevated in 30.2% of FDR and 19.4% of SDR of index patients with elevated Lp(a) compared with 6.2% in FDR (p < 0.001) and 5.6% in SDR (p = 0.007) of index patients with low Lp(a). The number (95%CI) of FDR needed to be screened to identify one individual with elevated Lp(a) was 3.3 (2.7-4.2) when the index patient had elevated Lp(a), compared with 16.1 (10.0-30.8) for low Lp(a) (p < 0.001). Corresponding numbers for SDR were 5.1 (3.4-8.8) and 17.8 (9.3-45.2) (p = 0.006). CONCLUSIONS: Cascade screening for elevated Lp(a) in relatives of patients with CAD is feasible in a real-world setting. Screening was up to five times more effective when initiated from patients with elevated Lp(a) than with low.

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Cite This Study

Littmann et al. (2026) conducted an observational in Coronary artery disease (n=1,499). Cascade screening from index patients with elevated Lp(a) (≥170 nmol/L) vs. Cascade screening from index patients with low Lp(a) (<70 nmol/L) was evaluated on Elevated Lp(a) in first-degree relatives (NNT 3.3, 95% CI 2.7-4.2, p=<0.001). Cascade screening initiated from CAD patients with elevated Lp(a) identified elevated Lp(a) in 30.2% of first-degree relatives, compared to 6.2% when initiated from patients with low Lp(a) (P<0.001).

synapsesocial.com/papers/69f1a1e0edf4b468248072e1 https://doi.org/10.1016/j.atherosclerosis.2026.120759

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Lipoprotein(a) cascade screening in coronary artery disease

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

Lipoprotein(a) cascade screening in coronary artery disease

Key Points

Study Design

Structured PICO

Main Result

Ask about this paper

Implication

Abstract

Discussion

Cite This Study

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