AHA Scientific Sessions 2026 Abstract · Nov 2, 2026
Impact of an Electronic Health Record Best Practice Advisory on Lipoprotein(a) Testing and Downstream Lipid Management
By Fan Y, FAN W, Hu X et al.
Background: Lipoprotein(a) [Lp(a)] is a genetically determined, independent cardiovascular risk factor elevated in approximately 20% of adults overall and up to 33% in those with atherosclerotic cardiovascular disease, yet fewer than 5% of eligible U.S. adults typically undergo testing despite guideline recommendations for universal testing. UC Irvine Health implemented an electronic health record (EHR)-based Best Practice Advisory (BPA) to prompt Lp(a) testing among patients with ASCVD, familial hypercholesterolemia, aortic stenosis, family history of cardiovascular disease, or LDL-C ≥190 mg/dL. We evaluated the impact of this BPA on Lp(a) testing and downstream lipid management. Methods: We conducted a quasi-experimental study using EHR data from the University of California Health Data Warehouse. The BPA-exposed group included 610 UCI Health patients whose clinicians received an Lp(a) BPA between January 2024 and December 2025, with the index date defined as the first BPA alert. Clinically eligible patients from other UC health systems served as controls and were assigned a pseudo-index date. Propensity scores incorporating demographics, BPA eligibility criteria, comorbidities, baseline medications, vital signs, lipid measures, area deprivation index, insurance, physician type and index year were used for 1:4 nearest-neighbor matching. Outcomes included Lp(a) testing, lipid-lowering therapy (LLT) initiation, and achievement of LDL-C <70 and <55 mg/dL within 12 months follow-up. Results: A total of 610 BPA-exposed patients and 2,440 matched controls were included. BPA exposure was associated with substantially higher Lp(a) testing rate within 12 months post index compared with matched controls (46.1% vs. 3.8%), including among patients with ASCVD (44.8% vs. 3.8%) and those without ASCVD (50.0% vs. 4.0%) (all p<0.001). In doubly robust logistic regression, BPA exposure was strongly associated with Lp(a) testing (adjusted OR: 22.86; 95% CI: 17.26-30.27; p<0.001). BPA-exposed patients also had a trend for higher initiation rates of any lipid-lowering therapy (7.9% vs. 6.0%), statin therapy (7.4% vs. 5.6%), and high-intensity statin therapy (7.5% vs. 5.6%) (adjusted OR for any LLT 1.49 [1.00-2.22]). LDL-C goal achievement was higher in the BPA group for LDL-C <70 mg/dL (22.6% vs. 15.3%, p=0.08) and LDL-C <55 mg/dL (11.3% vs. 5.2%, p=0.03). Conclusions: Implementation of an EHR-based Lp(a) BPA was associated with markedly higher Lp(a) testing and modest improvements in lipid-lowering therapy initiation and LDL-C goal achievement compared with usual care. These findings suggest that targeted clinical decision support may be a scalable strategy to close gaps in Lp(a) testing.