Lipoprotein(a) testing in clinical practice: real-life data from a large healthcare provider

Zafrir, Barak; Aker, Amir; Saliba, Walid

doi:10.1093/eurjpc/zwac124

Cited by 18 publications

(16 citation statements)

References 10 publications

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“…1,2,49 Elevated Lp(a) is highly prevalent 1,18 and is considered an independent, causal, and continual risk factor for ASCVD and CAVS; however, it is infrequently measured in clinical practice. 2,5 The ASCVD risk remains, even when the risk attributable to LDL-C is reduced by statin therapy. 1,50 Presently, the only intervention to lower Lp(a) is lipoprotein apheresis, although it appears that PCSK9 inhibitors are effective in lowering Lp(a) and reducing CV events.…”

Section: Discussionmentioning

confidence: 99%

“…21,33,36,37,[40][41][42][43][44] Because there is a direct relationship between Lp(a) levels and ASCVD risk, Lp(a) measurement can provide important prognostic information, assist in determining the aggressiveness of management of other ASCVD risk factors, and aid the clinician in planning for ASCVD screening and follow up. 1,2,5,11,18 Indications for Measurement of Lp(a)…”

Section: Screening and Testingmentioning

confidence: 99%

“…3,4 Although data on elevated Lp(a) continue to accumulate and multiple treatment guidelines have noted its importance and high prevalence, Lp(a) is seldom measured in clinical practice even among patients with existing ASCVD. 2,5 Such practices may change because highly effective RNA-based therapies targeting elevated Lp(a) are in Phase III CV outcome trials, with initial results expected in 2025. 6 This review provides relevant data on Lp(a), including clinical guidance for identifying and managing patients with elevated levels.…”

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confidence: 99%

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Elevated Lp(a): Guidance for Identifying and Managing Patients

Hilleman,

Vacek,

Backes

2024

Southern Medical Journal

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Section: Discussionmentioning

confidence: 99%

Section: Screening and Testingmentioning

confidence: 99%

mentioning

confidence: 99%

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Elevated Lp(a): Guidance for Identifying and Managing Patients

Hilleman,

Vacek,

Backes

2024

Southern Medical Journal

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“…Last, despite guidelines advocating the measurement of Lp(a) at least once in an individual’s lifetime, routine measurement of Lp(a) in current clinical practice remains uncommon . For example, in Germany, Lp(a) was measured in fewer than 1% of patients with known ASCVD, and in Israel only 0.1% of individuals within a health maintenance organization had their Lp(a) measured . The poor uptake of routine Lp(a) testing lends further support to advocate cascade screening for high Lp(a) levels.…”

Section: Discussionmentioning

confidence: 99%

“…22 For example, in Germany, Lp(a) was measured in fewer than 1% of patients with known ASCVD, and in Israel only 0.1% of individuals within a health maintenance organization had their Lp(a) measured. 20,23 The poor uptake of routine Lp(a) testing lends further support to advocate cascade screening for high Lp(a) levels. Fortunately, the clustering of high Lp(a) levels within families makes it an easy target for risk stratification in those families.…”

Section: Race and Ethnicitymentioning

confidence: 99%

Concordance of a High Lipoprotein(a) Concentration Among Relatives

Reeskamp,

Tromp,

Patel

et al. 2023

JAMA Cardiol

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ImportanceLipoprotein(a) (Lp[a]) concentrations are a highly heritable and potential causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Recent consensus statements by the European Atherosclerosis Society and American Heart Association recommend screening of relatives of individuals with high Lp(a) concentrations, but the expected yield of this approach has not been quantified in large populations.ObjectiveTo measure the prevalence of high Lp(a) concentrations among first- and second-degree relatives of individuals with high Lp(a) concentrations compared with unrelated participants.Design, Setting, and ParticipantsIn this cross-sectional analysis, pairs of first-degree (n = 19 899) and second-degree (n = 9715) relatives with measured Lp(a) levels from the UK Biobank study and random pairs of unrelated individuals (n = 184 764) were compared. Data for this study were collected from March 2006 to August 2010 and analyzed from December 2021 to August 2023.ExposureSerum Lp(a) levels, with a high Lp(a) level defined as at least 125 nmol/L.Main Outcome and MeasureConcordance of clinically relevant high Lp(a) levels in first- and second-degree relatives of index participants with high Lp(a) levels.ResultsA total of 52 418 participants were included in the analysis (mean [SD] age, 57.3 [8.0] years; 29 825 [56.9%] women). Levels of Lp(a) were correlated among pairs of first-degree (Spearman ρ = 0.45; P &lt; .001) and second-degree (Spearman ρ = 0.22; P &lt; .001) relatives. A total of 1607 of 3420 (47.0% [95% CI, 45.3%-48.7%]) first-degree and 514 of 1614 (31.8% [95% CI, 29.6%-34.2%]) second-degree relatives of index participants with high Lp(a) levels also had elevated concentrations compared with 4974 of 30 258 (16.4% [95% CI, 16.0%-16.9%]) pairs of unrelated individuals. The concordance in high Lp(a) levels was generally consistent among subgroups (eg, those with prior ASCVD, postmenopausal women, and statin users). The odds ratios for relatives to have high Lp(a) levels if their index relative had a high Lp(a) level compared with those whose index relatives did not have high Lp(a) levels were 7.4 (95% CI, 6.8-8.1) for first-degree relatives and 3.0 (95% CI, 2.7-3.4) for second-degree relatives.Conclusions and RelevanceThe findings of this cross-sectional study suggest that the yield of cascade screening of first-degree relatives of individuals with high Lp(a) levels is over 40%. These findings support recent recommendations to use this approach to identify additional individuals at ASCVD risk based on Lp(a) concentrations.

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