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

Abstract

Background Evidence support a causal role of lipoprotein(a) [Lp(a)] in the development of atherosclerotic cardiovascular disease (ASCVD). Novel treatment options are emerging and recent guidelines recommend screening Lp(a) levels at least once during lifetime. However, significant variance exists regarding the incorporation of Lp(a) into patient care. Purpose To investigate patterns of Lp(a) measurement in a large health maintenance organization (HMO) and describe clinical characteristics associated with elevated Lp(a) levels. Methods Retrospective analysis of all Lp(a) laboratory tests performed between January 2015 and December 2021 in a single HMO providing health care for approximately 4.6 million insured members. Results Overall, 4,539 individuals were tested for Lp(a). Analysis was limited to the adult population (n=3900). Number of persons tested yearly increased progressively from 89 in the year 2015 to 1523 in 2021. Mean age was 55±15 years (39% females), 15% had family history of coronary disease, 40% ischemic heart disease, 7% prior stroke and 9% peripheral artery disease (PAD). Baseline low-density lipoprotein cholesterol (LDL-C) >190 mg/dl was evident in 21% of patients. Lp(a) level >125 nmol/l (∼50 mg/dl) was noted in 21.5%. In a multivariable logistic regression model, prior myocardial infarction (odds ratio 1.38, 95% confidence interval 1.16–1.64), PAD (1.29, 1–1.68), peak LDL-C>190 mg/dl (1.35, 1.12–1.62) and use of statins (1.54, 1.28–1.85), were independently associated with elevated Lp(a) levels >125 nmol/l, whereas an inverse association was seen with obesity (0.74, 0.62–0.88). Of the patients with elevated Lp(a), 72.4% were treated with statin and/or ezetimibe and 1.9% with PCSK9 inhibitors. Conclusions The reporting of Lp(a) levels is increasing, though it is still measured in a small portion of the population. Presence of ASCVD and severe hyperlipidemia may identify patients that should be considered for screening for increased Lp(a) levels. The use of PCSK9 inhibitors in those with elevated Lp(a) is yet considerably low. Funding Acknowledgement Type of funding sources: None.

Extreme lipoprotein(a) in clinical practice: A cross sectional study

“…This study is part of a retrospective analysis of Lp(a) laboratory tests performed in insured members of the Clalit Health Services (CHS) in Israel, providing inclusive health care for about half of the country's population. The methodology and main features of the overall study population have been previously published [ 9 ]. In short, data on all individuals insured by the CHS in whom Lp(a) testing was performed during the years 2015–2021 were retrieved.…”

“…It is suggested that this approach may identify people with very high Lp(a) levels >430 nmol/L who may have a lifetime risk of ASCVD equivalent to those with heterozygous familial hypercholesterolemia (HeFH) [ 7 ]. Nevertheless, although the reporting of Lp(a) levels is increasing, it is still measured in only a minority of the population, and data on patients with very high Lp(a) levels in real-life clinical settings are lacking [ 9 ].…”