Key result
Adding Lp(a) to PREVENT equations makes ~3% of high-Lp(a) patients newly statin-eligible.
Why the study?
Although elevated lipoprotein(a) is associated with ASCVD and universal adult testing is recommended, how to use Lp(a) for clinical decision-making in low-risk patients remains uncertain.
Does incorporating measured or imputed Lp(a) levels into the PREVENT ASCVD risk equations change predicted risk and statin eligibility in low-risk adults not otherwise indicated for statin therapy under the 2026 ACC/AHA dyslipidemia guideline?
Cohort (n=28,651)
Yes
Does incorporating measured or imputed Lp(a) levels into the PREVENT ASCVD risk equations change predicted risk and statin eligibility in low-risk adults not otherwise indicated for statin therapy under the 2026 ACC/AHA dyslipidemia guideline?
Integrating Lp(a) into PREVENT 10-year and 30-year ASCVD risk equations reclassifies a meaningful proportion of otherwise low-risk adults—especially older individuals and those with Lp(a) ≥125 nmol/L—above statin eligibility thresholds under the 2026 ACC/AHA dyslipidemia guideline.
Answers are grounded in this paper and cite their sources.
Lp(a) addition to PREVENT equations yields minimal statin reclassification in low-risk adults; leaves open prospective outcome validation.
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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Faridi et al. (2026) conducted a cohort in Low-risk primary prevention adults without current statin indications (n=28,651). Incorporation of measured or imputed Lipoprotein(a) [Lp(a)] into PREVENT ASCVD risk equations vs. Standard PREVENT ASCVD risk equations without Lp(a) was evaluated on New statin eligibility defined as recalculated 10-year PREVENT ASCVD risk ≥3% after incorporating Lp(a). Adding Lp(a) to 10-year PREVENT risk equations made 3.3% of low-risk patients with measured Lp(a) ≥125 nmol/L and 0.1% with imputed Lp(a) of 125 nmol/L newly eligible for statin therapy.
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