AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Traditional Lipid Testing and Risk-Enhancing Biomarker Testing in US Health Systems Across PREVENT Estimated Cardiovascular Risk Categories, 2016-2025
By Bajwa H, Hallaj S, Duran E et al.
Background: Prior studies have generally examined lipid testing trends in individual biomarkers or selected populations, leaving multi-marker testing patterns and their alignment with cardiovascular risk incompletely characterized. Research Questions: 1) How have testing rates for traditional lipid testing and other risk-enhancing biomarkers such as apolipoprotein B (ApoB), lipoprotein(a) [Lp(a)], high-sensitivity C-reactive protein (hs-CRP), and coronary artery calcium (CAC) changed across US health systems from 2016-2025? 2) How do traditional lipid testing and risk-enhancing biomarker testing align with cardiovascular risk, as estimated by the PREVENT-ASCVD model? Methods: Observational analysis of 611,637,484 adult patient-years from Epic Cosmos health systems. Annual testing rates were expressed as events per 1,000 eligible patient-years with Wilson 95% confidence intervals. Temporal trends were summarized by absolute change between baseline (2016) and final (2025) calendar years and by year-versus-baseline odds ratios from quasibinomial generalized linear models. Risk-enhancing biomarker testing rates stratified by PREVENT 10-year risk tier were computed descriptively as annual rates per 1,000 eligible patient-years within each risk stratum. Results: Same-day four-component traditional lipid panel (total cholesterol, HDL-C, triglycerides, LDL-C by any method) completeness rates rose across the decade, from 81.9% to 92.5%. Risk-enhancing biomarker testing remained uncommon but rose faster than traditional testing: between 2016 and 2025, ApoB testing rose 17.1-fold, Lp(a) 15.8-fold, CAC 7.1-fold, hs-CRP 1.6-fold. All aggregate ORs reached p < 0.001. Among patient-years with computable PREVENT 10-year ASCVD risk, Lp(a) testing rates diverged such that by 2025 the Borderline and Low tiers were tested most frequently and the High (≥10%) tier least frequently. ApoB testing rose across all PREVENT 10-year-risk tiers from 2022 onward but ended 2025 with rates that were higher in the Low and Borderline tiers than in the High tier. CAC testing diverged progressively, with the Borderline and Intermediate tiers separating from Low and High tiers from 2021 onward to become the most-tested groups by 2025 (Figure 1). hs-CRP testing remained consistently highest in the High tier throughout the decade. Conclusion: Across 611 million US adult patient-years, traditional lipid testing rates rose while risk-enhancing biomarker testing rates, though rising, remained uncommon. The alignment between guideline recommendations and testing rates varied by biomarker: CAC testing rates were higher in Borderline and Intermediate risk populations, concordant with recent recommendations, however ApoB and Lp(a) testing rates were lowest in the High tier, revealing a gap between guidelines and clinical practice among populations with high cardiovascular risk.