Andrew Kao MD, Jianhui Zhu PhD, Brenden Boyle BS, Floyd Thoma BS, Harpreet Bhatia MD, Suresh Mulukutla MD, Matthew Starr MD, Anum Saeed MD, Jacqueline Levene DO
{"title":"Healthcare system level testing for lipoprotein(a) amongst ischemic and cryptogenic stroke patient population","authors":"Andrew Kao MD, Jianhui Zhu PhD, Brenden Boyle BS, Floyd Thoma BS, Harpreet Bhatia MD, Suresh Mulukutla MD, Matthew Starr MD, Anum Saeed MD, Jacqueline Levene DO","doi":"10.1016/j.jacl.2025.04.014","DOIUrl":null,"url":null,"abstract":"<div><h3>Background/Synopsis</h3><div>Elevated Lp(a) is associated with the incidence of premature coronary heart disease, aortic stenosis, and ischemic stroke. While its association with strokes secondary to large artery atherosclerosis is robust, data on Lp(a) and its involvement in cryptogenic stroke or embolic stroke of undetermined source (ESUS) is scarce. Even though the National Lipid Association (NLA) recommends Lp(a) testing for all individuals, clinically Lp(a) testing remains limited in stroke patients.</div></div><div><h3>Objective/Purpose</h3><div>This study aims to assess both the frequency at which Lp(a) is checked in patients presenting with ischemic stroke, including cryptogenic stroke, within the University of Pittsburgh Medical Center (UPMC) health system and the association of Lp(a) with cryptogenic stroke.</div></div><div><h3>Methods</h3><div>We queried the UPMC electronic healthcare records (EHR), spanning over 40 hospital and 200 outpatient sites, from 2010 to 2020 to identify individuals with ICD-9 and ICD-10 codes consistent with non-hemorrhagic ischemic strokes and cryptogenic strokes. Demographic, medications, comorbidity, and serologic/biomarker data was additionally obtained within one year of stroke for patients ages 18 – 60 and with ICD-9 or ICD-10 codes for cryptogenic stroke, stroke, ischemic stroke, or cerebral vascular incident. Exclusion criteria includes age < 18 or > 60 or history of hemorrhagic stroke.</div></div><div><h3>Results</h3><div>A total of 14,689 patients met inclusion criteria for this study. 8,395 (57.1%) were male and 6,294 (42.8%) were female. 6,386 individuals (43.4%) had an ischemic stroke based on ICD-9 and ICD-10 diagnosis codes and 8,303 (56.5%) individuals had a cryptogenic stroke based on ICD-9 and ICD-10 diagnosis codes. Of note, 1,262 (8.6%) individuals had a transient ischemic attack based on ICD-9 and ICD-10 diagnosis codes; this diagnosis was included under cryptogenic stroke only. Only 132 (0.9%) individuals had Lp(a) tested: 59 (0.9%) in those with ischemic stroke and 73 (0.9%) in those with cryptogenic stroke (p-value 0.78). The mean Lp(a) value in those with ischemic stroke was 73.0 nmol/L (range 21.0 – 2370.0 nmol/L) and the mean Lp(a) value in those with cryptogenic stroke was 44.0 nmol/L (range 17.0 – 174.0 nmol/L) (p-value 0.262).</div></div><div><h3>Conclusions</h3><div>Our study demonstrates that despite the NLA's societal recommendation for universal Lp(a) testing, Lp(a) remains undertested in a high risk stroke population within a large health system spanning rural and urban areas. Given the small numbers in this population, an ongoing, prospective arm to this study has been designed to evaluate Lp(a) in patients presenting with cryptogenic stroke.</div></div>","PeriodicalId":15392,"journal":{"name":"Journal of clinical lipidology","volume":"19 3","pages":"Pages e9-e11"},"PeriodicalIF":3.6000,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":null,"platform":"Semanticscholar","paperid":null,"PeriodicalName":"Journal of clinical lipidology","FirstCategoryId":"3","ListUrlMain":"https://www.sciencedirect.com/science/article/pii/S193328742500090X","RegionNum":3,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"","PubModel":"","JCR":"Q2","JCRName":"PHARMACOLOGY & PHARMACY","Score":null,"Total":0}
引用次数: 0
Abstract
Background/Synopsis
Elevated Lp(a) is associated with the incidence of premature coronary heart disease, aortic stenosis, and ischemic stroke. While its association with strokes secondary to large artery atherosclerosis is robust, data on Lp(a) and its involvement in cryptogenic stroke or embolic stroke of undetermined source (ESUS) is scarce. Even though the National Lipid Association (NLA) recommends Lp(a) testing for all individuals, clinically Lp(a) testing remains limited in stroke patients.
Objective/Purpose
This study aims to assess both the frequency at which Lp(a) is checked in patients presenting with ischemic stroke, including cryptogenic stroke, within the University of Pittsburgh Medical Center (UPMC) health system and the association of Lp(a) with cryptogenic stroke.
Methods
We queried the UPMC electronic healthcare records (EHR), spanning over 40 hospital and 200 outpatient sites, from 2010 to 2020 to identify individuals with ICD-9 and ICD-10 codes consistent with non-hemorrhagic ischemic strokes and cryptogenic strokes. Demographic, medications, comorbidity, and serologic/biomarker data was additionally obtained within one year of stroke for patients ages 18 – 60 and with ICD-9 or ICD-10 codes for cryptogenic stroke, stroke, ischemic stroke, or cerebral vascular incident. Exclusion criteria includes age < 18 or > 60 or history of hemorrhagic stroke.
Results
A total of 14,689 patients met inclusion criteria for this study. 8,395 (57.1%) were male and 6,294 (42.8%) were female. 6,386 individuals (43.4%) had an ischemic stroke based on ICD-9 and ICD-10 diagnosis codes and 8,303 (56.5%) individuals had a cryptogenic stroke based on ICD-9 and ICD-10 diagnosis codes. Of note, 1,262 (8.6%) individuals had a transient ischemic attack based on ICD-9 and ICD-10 diagnosis codes; this diagnosis was included under cryptogenic stroke only. Only 132 (0.9%) individuals had Lp(a) tested: 59 (0.9%) in those with ischemic stroke and 73 (0.9%) in those with cryptogenic stroke (p-value 0.78). The mean Lp(a) value in those with ischemic stroke was 73.0 nmol/L (range 21.0 – 2370.0 nmol/L) and the mean Lp(a) value in those with cryptogenic stroke was 44.0 nmol/L (range 17.0 – 174.0 nmol/L) (p-value 0.262).
Conclusions
Our study demonstrates that despite the NLA's societal recommendation for universal Lp(a) testing, Lp(a) remains undertested in a high risk stroke population within a large health system spanning rural and urban areas. Given the small numbers in this population, an ongoing, prospective arm to this study has been designed to evaluate Lp(a) in patients presenting with cryptogenic stroke.
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.
Sections of Journal of clinical lipidology 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.