Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study

Hu, Xingdi; Cristino, Joaquim; Gautam, Raju; Mehta, Rina; Amari, Diana T.; Heo, Ji Haeng; Wang, Siwei; Wong, Nathan D.

doi:10.1016/j.ajpc.2023.100476

Cited by 8 publications

(4 citation statements)

References 28 publications

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“…An analysis of health claims data for >9000 patients showed that only 0.6% of primary prevention and 0.7% of secondary prevention patients with laboratory data had lipoprotein(a) levels measured. 57…”

Section: High Blood Cholesterol and Other Lipidsmentioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

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434

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BACKGROUND: The American Heart Association (AHA), in conjunction with the National Institutes of Health, annually reports the most up-to-date statistics related to heart disease, stroke, and cardiovascular risk factors, including core health behaviors (smoking, physical activity, nutrition, sleep, and obesity) and health factors (cholesterol, blood pressure, glucose control, and metabolic syndrome) that contribute to cardiovascular health. The AHA Heart Disease and Stroke Statistical Update presents the latest data on a range of major clinical heart and circulatory disease conditions (including stroke, brain health, complications of pregnancy, kidney disease, congenital heart disease, rhythm disorders, sudden cardiac arrest, subclinical atherosclerosis, coronary heart disease, cardiomyopathy, heart failure, valvular disease, venous thromboembolism, and peripheral artery disease) and the associated outcomes (including quality of care, procedures, and economic costs). METHODS: The AHA, through its Epidemiology and Prevention Statistics Committee, continuously monitors and evaluates sources of data on heart disease and stroke in the United States and globally to provide the most current information available in the annual Statistical Update with review of published literature through the year before writing. The 2024 AHA Statistical Update is the product of a full year’s worth of effort in 2023 by dedicated volunteer clinicians and scientists, committed government professionals, and AHA staff members. The AHA strives to further understand and help heal health problems inflicted by structural racism, a public health crisis that can significantly damage physical and mental health and perpetuate disparities in access to health care, education, income, housing, and several other factors vital to healthy lives. This year’s edition includes additional global data, as well as data on the monitoring and benefits of cardiovascular health in the population, with an enhanced focus on health equity across several key domains. RESULTS: Each of the chapters in the Statistical Update focuses on a different topic related to heart disease and stroke statistics. CONCLUSIONS: The Statistical Update represents a critical resource for the lay public, policymakers, media professionals, clinicians, health care administrators, researchers, health advocates, and others seeking the best available data on these factors and conditions.

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Section: High Blood Cholesterol and Other Lipidsmentioning

confidence: 99%

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Martin,

Aday,

Almarzooq

et al. 2024

Circulation

Self Cite

434

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“…An analysis of U.S. claims data revealed that only 0.7% of secondary prevention patients were tested for Lp(a). 19 Reasons behind the consistently low testing rates for Lp(a) in patients with ASCVD are likely multifactorial, and may include lack of clinician understanding or awareness of Lp(a) as a prevalent and causal risk factor for ASCVD 20 . Further, current clinical guidelines are inconsistent about recommendations for Lp(a) testing, though most recommend testing in high-risk patients 3,9 , if not all patients at least once in a lifetime 4 .…”

Section: Discussionmentioning

confidence: 99%

“…Older age was associated with a lower likelihood of Lp(a) testing; this may be related to the NLA guidelines which specifically recommend Lp(a) testing for individuals with premature ASCVD, and who are therefore young by definition 9 . Black race was also associated with a 24% lower likelihood of Lp(a) testing; this likely represents a disparity in care, as Black individuals are known to have generally higher Lp(a) levels than White individuals, with correspondingly higher Lp(a)-related ASCVD risk 19,23 . As far as we are aware, this disparity in Lp(a) testing has not been shown before, and is important for addressing health equity in ASCVD prevention and management.…”

Section: Discussionmentioning

confidence: 99%

Lipoprotein(a) testing in Patients with Atherosclerotic Cardiovascular Disease in Five Large U.S. Health Systems

Shah,

Mulder,

Lydon

et al. 2024

Preprint

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IntroductionLipoprotein (a) [Lp(a)] is an independent, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). However, testing patterns remain variable and it is unclear what patient level factors are associated with Lp(a) testing, and if testing changes clinical management.MethodsA retrospective study using electronic medical record data from five health systems in the CardioHealth Alliance identified an ASCVD cohort that was divided into those with a Lp(a) test and those without a Lp(a) test between 2019-2021. Baseline characteristics and initiation of lipid lowering therapy (LLT) was assessed. Multivariable regression modeling was used to determine factors associated with Lp(a) testing.ResultsAmong 595,684 ASCVD patients, only 2,587 (0.4%) were tested for Lp(a) between 2019 and 2021. In adjusted models, those who were older or Black were less likely to have Lp(a) testing, while those with familial hypercholesterolemia, ischemic stroke/TIA, PAD, prior LLT, or LDL-C ≥130mg/dL were more likely to be tested. Those with a Lp(a) test, regardless of the Lp(a) value, were more frequently initiated on any statin therapy (30.3% vs. 10.6%, p<0.001), ezetimibe (7.65 vs. 0.8%, p <0.001), or PCSK9i (6.7% vs. 0.3%, p <0.001) compared with those without a test. Those with an elevated Lp(a) level more frequently initiated ezetimibe (11.5% vs. 5.9%, P <0.001) or PCSK9i (10.9% vs. 4.8%, P <0.001), but not statin therapy.ConclusionsLp(a) testing in ASCVD patients is infrequent, with evidence of disparities among older or Black individuals. Testing for Lp(a), regardless of level, is associated with greater initiation of any LLT, while elevated Lp(a) is associated with greater initiation of non-statin LLT. Overall, initiation of LLT remained low, despite guideline indications for LLT in ASCVD patients. There is a critical need for multidisciplinary and inclusive approaches to raise awareness for Lp(a) testing and its implications on management.

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“…Rates of Lp(a) testing have ranged from 0.1% to 1% in retrospective studies to as high as 13.9% in the Lp(a)HERITAGE study. 3 , 4 , 5 , 6 , 7 Commonly used cut points are Lp(a) levels >30 mg/dL or >50 mg/dL, 8 which have been derived mainly from Caucasian populations. Lp(a) values vary by race and ethnicity, with the highest values seen in Black and South Asian adults.…”

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confidence: 99%

E pluribus unum

Patel,

Bhatia,

Spitz

2024

JACC: Advances

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Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study

Cited by 8 publications

References 28 publications

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

2024 Heart Disease and Stroke Statistics: A Report of US and Global Data From the American Heart Association

Lipoprotein(a) testing in Patients with Atherosclerotic Cardiovascular Disease in Five Large U.S. Health Systems

E pluribus unum

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