Lipoprotein(a) Screening Recommendations by Age
Measure Lp(a) at least once in every adult's lifetime, ideally starting in early adulthood (age 20 or older), with earlier testing (as young as age 2) in children with a family history of premature cardiovascular disease or significant hypercholesterolemia. 1, 2
Universal Screening Approach
The most recent evidence supports a paradigm shift toward broader Lp(a) screening:
All adults should have Lp(a) measured at least once in their lifetime to identify those at very high lifetime cardiovascular risk, as Lp(a) levels are genetically determined and remain stable throughout adult life. 1, 2, 3
The 2024 National Lipid Association update now recommends measuring Lp(a) at least once in every adult for risk stratification, representing a significant expansion from prior targeted screening approaches. 2
Lp(a) should only be measured once (or repeated at puberty in children) because levels are genetically determined and do not change significantly in adulthood. 4, 1
Age-Specific Screening Recommendations
Children and Adolescents
Measure Lp(a) as early as age 2 years in children with a family history of early cardiovascular disease (men <55 years, women <65 years) or significant hypercholesterolemia (LDL-C ≥190 mg/dL or total cholesterol ≥240 mg/dL). 1, 5
Repeat testing at puberty (≥12 years) even if previous values were normal, as Lp(a) levels can increase by 22-43% from age 8 through adulthood, with considerable intra-individual variation (70%). 1, 6
Universal lipid screening between ages 9-11 years or 17-21 years provides an opportunity to include Lp(a) measurement, which would enable family cascade screening. 7
Adults Without Specific Risk Factors
Begin Lp(a) screening in early adulthood (age 20 or older) as part of a one-time lifetime measurement strategy. 2, 3
The European Society of Cardiology recommends measuring Lp(a) at least once in every adult's lifetime. 1
High-Risk Adults (Priority Screening)
Measure Lp(a) immediately at any age in adults with the following indications: 1
- Personal or family history of premature atherosclerotic cardiovascular disease (men <55 years, women <65 years)
- Unexplained early cardiovascular events in first-degree relatives
- Known elevated Lp(a) in first-degree relatives (>200 nmol/L or >75 nmol/L)
- Familial hypercholesterolemia diagnosis
- Recurrent cardiovascular disease despite optimal statin therapy
- Borderline 10-year cardiovascular risk (5-15%) where Lp(a) may reclassify risk
Risk Stratification Thresholds
Once measured, interpret Lp(a) levels as follows: 2
- Low risk: <75 nmol/L (<30 mg/dL)
- Intermediate risk: 75-125 nmol/L (30-50 mg/dL)
- High risk: ≥125 nmol/L (≥50 mg/dL)
- Very high risk: >200 nmol/L (>75 nmol/L), which combined with elevated LDL-C increases myocardial infarction risk 10-fold or higher 1
Cascade Screening
Perform cascade screening of first-, second-, and third-degree biological relatives when elevated Lp(a) is identified, as approximately 1 in 5 individuals have elevated Lp(a) levels. 1, 2
Lp(a) is inherited in a co-dominant fashion, making family screening highly effective for identifying additional at-risk individuals. 7
Important Clinical Caveats
Avoid routine screening in the absence of specific indications according to older guidelines, though the 2024 NLA update now supports universal screening. 4, 2
Despite Lp(a) being an established independent causal risk factor affecting approximately 1 in 5 individuals, measurement rates remain low in clinical practice, warranting improved screening strategies. 2
The single measurement approach is justified because Lp(a) levels attain adult levels by age 2 and remain stable for life, though the pediatric data suggest remeasurement at puberty may be warranted. 6, 7
Measuring Lp(a) only once during childhood may lead to substantial over- or underestimation due to age-related increases and intra-individual variation, so consider repeat measurement in adulthood if only childhood assessment exists. 6