Race/ethnicity and socioeconomic status affect the assessment of lipoprotein(a) levels in clinical practice

IF 3.6 3区医学 Q2 PHARMACOLOGY & PHARMACY

Journal of clinical lipidology Pub Date : 2024-09-01 DOI:10.1016/j.jacl.2024.07.003

Marianna Pavlyha MD , Yihao Li MS , Sarah Crook MS , Brett R. Anderson MD , Gissette Reyes-Soffer MD

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引用次数: 0

Abstract

BACKGROUND AND OBJECTIVE

High lipoprotein(a) [Lp(a)] levels are a risk factor for atherosclerotic cardiovascular disease (ASCVD), however Lp(a) ordering in clinical practice is low. This study examines how race/ethnicity and socioeconomic status influence Lp(a) ordering.

METHODS

This is a single center, retrospective study (2/1/2020-6/30/2023) using electronic medical records of adults with at least one personal ICD-10 diagnosis of ASCVD, aortic valve stenosis, resistant hypercholesterolemia (low-density lipoprotein cholesterol >160 mg/dL on statin therapy), and family history of ASCVD or high Lp(a). We evaluated Lp(a) level differences among racial/ethnic groups and sexes. We also assessed associations between diagnosis type, diagnosis number, age at diagnosis, race/ethnicity, socioeconomic score (based on zip codes), public health coverage and the presence of Lp(a) orders.

RESULTS

4% of our cohort (N=2,249 in 56,833) had an Lp(a) order (17.3% of whom identified as Hispanic, 8.7% non-Hispanic Black, 47.5% non-Hispanic White, and 27% Asian/other). Non-Hispanic Black and Hispanic patients had lower rates of Lp(a) orders (0.17% and 0.28%, respectively) when compared to non-Hispanic White patients (2.35%), p < 0.001, however, their median Lp(a) levels were higher, p < 0.001. Individuals on Medicaid or belonging to deprived socioeconomic groups were less likely to have an Lp(a) order (incidence rate ratio [IRR] = 0.40, p < 0.001 and IRR = 0.39, p < 0.001 respectively). Certain diagnosis (carotid stenosis, family history of ASCVD and familial hypercholesterolemia) and multiple diagnoses (>2) resulted in more Lp(a) orders compared to only one diagnosis (p < 0.001).

CONCLUSIONS

Lp(a) ordering is low in patients with or at risk for ASCVD. Non-Hispanic Black and Hispanic patients are less likely to have an Lp(a) order. Individuals on Medicaid and residing in socioeconomically deprived neighborhoods are less likely to have an Lp(a) order. Lp(a) orders depend on the type and number of patients’ diagnoses.

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种族/民族和社会经济地位对临床实践中脂蛋白（a）水平评估的影响

高脂蛋白（a）水平是 ASCVD 的一个危险因素，但临床实践中脂蛋白（a）的订购率很低。本研究探讨了种族/民族和社会经济地位如何影响脂蛋白（a）的订购。这是一项单中心、回顾性研究（2/1/2020-6/30/2023），使用的是成人电子病历，至少有一项个人 ICD-10 诊断为 ASCVD、主动脉瓣狭窄、抵抗性高胆固醇血症（他汀类药物治疗后 LDL-C >160 mg/dL）、ASCVD 家族史或高脂蛋白（a）。我们评估了不同种族/族裔群体和性别之间的脂蛋白（a）水平差异。我们还评估了诊断类型、诊断次数、诊断时的年龄、种族、社会经济得分（基于邮政编码）、公共医疗保险和是否存在 Lp(a) 订单之间的关联。我们的队列中有 4% 的患者（56,833 人中有 2,249 人）有 Lp(a) 订单（西班牙裔占 17.3%，非西班牙裔黑人占 8.7%，非西班牙裔白人占 47.5%，亚裔/其他族裔占 27%）。与非西班牙裔白人患者（2.35%）相比，非西班牙裔黑人和西班牙裔患者的脂蛋白（a）订购率较低（分别为 0.17% 和 0.28%）（< 0.001），但他们的脂蛋白（a）水平中位数更高（< 0.001）。属于贫困社会经济群体或享受医疗补助的患者不太可能有脂蛋白（a）订单（IRR = 0.39，< 0.001 和 IRR = 0.40，< 0.001）。与只有一项诊断（< 0.001）的患者相比，某些诊断（颈动脉狭窄、ASCVD 家族史和 FH）和多项诊断（>2）会导致更多的 Lp(a) 订单。ASCVD 患者或高危患者的脂蛋白（a）订购量较低。非西班牙裔黑人和西班牙裔患者较少获得 Lp(a) 订单。居住在社会经济贫困地区和享受医疗补助（Medicaid）的患者也较少获得 Lp(a) 订单。Lp(a) 订单取决于患者诊断的类型和数量。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of clinical lipidology 医学-药学

CiteScore

7.00

自引率

6.80%

发文量

209

审稿时长

49 days

期刊介绍： Because the scope of clinical lipidology is broad, the topics addressed by the Journal are equally diverse. Typical articles explore lipidology as it is practiced in the treatment setting, recent developments in pharmacological research, reports of treatment and trials, case studies, the impact of lifestyle modification, and similar academic material of interest to the practitioner. While preference is given to material of immediate practical concern, the science that underpins lipidology is forwarded by expert contributors so that evidence-based approaches to reducing cardiovascular and coronary heart disease can be made immediately available to our readers. Sections of the Journal will address pioneering studies and the clinicians who conduct them, case studies, ethical standards and conduct, professional guidance such as ATP and NCEP, editorial commentary, letters from readers, National Lipid Association (NLA) news and upcoming event information, as well as abstracts from the NLA annual scientific sessions and the scientific forums held by its chapters, when appropriate.