Trends in Cardiometabolic Testing: Lipoprotein(a) and Natriuretic Peptide Testing

Despite decades of progress in identifying and managing critical risk factors, cardiovascular disease (CVD) remains the leading cause of death worldwide. Although there are few families that it doesn’t touch, we know some are more predisposed than others. 

To better understand individual risk, testing for biomarkers such as lipoprotein(a), or Lp(a), and a type of natriuretic peptide known as NT-proBNP are increasingly included in medical guidelines. As a result, millions of patients will be recommended for these tests in the coming years to improve the monitoring and management of CVD. 

This grants clinicians new opportunities to act early and potentially prevent CVD and late-stage heart failure in vulnerable populations. However, absorbing additional testing volume can pose a challenge for clinical laboratories. Fully automated technology and two-way partnerships with diagnostics providers will be critical for ongoing lab success.

Every adult, at least once

Approximately one in five individuals worldwide have elevated Lp(a) levels (defined as greater than 125nmol/L), placing them at increased risk of atherosclerotic cardiovascular disease (ASCVD). Unlike LDL cholesterol and other known CVD risk factors, up to 90 percent of individual variation in plasma Lp(a) levels is genetically determined and cannot be directly mitigated through diet, exercise, or statins.

In 2024, the National Lipid Association (NLA) released a scientific statement on the use of Lp(a) testing in clinical practice, encouraging all adults to be tested at least once in their lifetime due to its association with ASCVD. There is much work to be done in meeting this recommendation: One study found less than 0.3 percent of patients in the US underwent Lp(a) testing between 2012 and 2021.

Notably, the NLA statement specifically encourages Lp(a) to be measured in molar units where possible. Lp(a) comprises two components: apolipoprotein B100 (apo-B100) and apolipoprotein a or apo(a). Apo(a) components can vary considerably in size, which in turn, influences mass-based measurements. In January 2025, the first IVD test reporting Lp(a) concentration in molar units was cleared for use, providing an accurate measure of Lp(a) particle concentration, irrespective of apo(a) size.

While Lp(a) levels are not modifiable, clinicians can monitor and manage other CVD risk factors, such as smoking, among patients with elevated Lp(a). In parallel, therapies that are specifically designed to target and lower Lp(a) are currently in development. In any case, increasing rates of Lp(a) testing is a critical first step in understanding and managing individual risk.

Annual monitoring for people living with diabetes

Studies show more than one in five (22 percent) individuals with diabetes will experience heart failure. To help clinicians monitor and manage this heightened risk, the American Diabetes Association recently updated their Standard of Care Guidelines to highlight the connection between diabetes and heart failure. The guidelines now encourage testing individuals with diabetes for heart failure at least annually using a natriuretic peptide biomarker like NT-proBNP or a high-sensitivity cardiac troponin. Natriuretic peptides can play a critical role in identifying signs of heart failure early, so clinicians can monitor and hopefully prevent the patient from ever progressing to late-stage heart failure.

While NT-proBNP can be readily measured via a blood test, implementing annual testing and providing appropriate follow-up care at this scale can be a challenge for health systems. As of 2021, approximately 38.4 million Americans (11.6 percent of the population) had diabetes. Recognizing the high prevalence, some institutions are attempting to intervene in a stepwise manner by targeting those with diabetes who also have other comorbidities associated with heart failure, like obesity, renal dysfunction, and advanced age. However, as these protocols are implemented and awareness of the association between diabetes and heart failure grows, the protocols may soon expand to include all people with diabetes—the ultimate goal of the ADA recommendations.

Working together with diagnostics providers

Increased cardiometabolic testing for adults with diabetes, and all adults in the case of Lp(a), will translate to many millions of additional laboratory tests across the US in the coming years. As a diagnostics provider, we’re dedicated to helping laboratories succeed as these new challenges arise. We strive to listen and gather feedback on how we can further refine our analyzers, software, automation, and tests for their real-world use, so we can work together to provide cardiometabolic testing for patients everywhere.