ISC 2026 | Pearls and pitfalls of lipoprotein(a) testing to assess stroke risk

I think it’s important to remember that LPA has two different assays that are available. The older assay is a mass assay that looks at milligrams per deciliter, whereas the newer, more favored assay nowadays is in nanomoles per liter, which looks at particle number. The particle number is what most closely tracks with atherothrombotic risk. And so one pearl is that if you have the option to pick between two assays to always pick the nanomoles per liter, so that will give you a much more accurate risk estimate per person, whereas a mass assay may be a little bit more ambiguous because LPA molecules can be different sizes depending on the genetic makeup of a particular person. Another pearl to consider is that although we tend to group LPA into buckets of low, intermediate, and high risk depending on the absolute level of LPA, it’s really a continuum. So even within those categories, higher LPA is associated with increased atherothrombotic risk, both for heart disease and for stroke events. So important to consider that when you’re talking about risk decision-making and what to do in terms of treatment patterns. Some pitfalls to avoid with LPA is that people think there needs to be a special type of test or that patients need to be fasting. And actually, because it’s directly measured, this can be added on to an old blood work panel or it can be ordered with the next set of routine labs. So it’s a very simple, quick, and often inexpensive test to be able to get for a patient. Another pearl is that it typically is stable throughout the lifetime. So you only have to check it once. This isn’t something that you have to serially trend or repeat check. So if you have a normal value, you’ve already completed that box. You can move on to other risk factor assessments.

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