Management of patients with elevated Lp(a) remains challenging, with non-standardised clinical practices and substantial gaps in care, even among patients with very high-risk Lp(a) levels and established atherosclerotic cardiovascular disease (ASCVD). These were the findings from an analysis of results from a US community health centre participating in an American Heart Association initiative to drive awareness and shared decision-making around Lp(a) testing and cardiovascular (CV) risk management.