Healthcare system level testing for lipoprotein(a) amongst ischemic and cryptogenic stroke patient population

IF 3.6 3区 医学 Q2 PHARMACOLOGY & PHARMACY
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
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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.
在缺血性和隐源性卒中患者人群中脂蛋白(a)的医疗保健系统水平测试
背景/摘要Lp(a)升高与早发冠心病、主动脉狭窄和缺血性脑卒中的发生率相关。虽然它与继发于大动脉粥样硬化的中风的关联是可靠的,但关于Lp(a)及其与隐源性卒中或不明来源栓塞性卒中(ESUS)的关系的数据很少。尽管国家脂质协会(NLA)建议对所有个体进行脂蛋白(a)检测,但临床脂蛋白(a)检测在中风患者中仍然有限。目的/目的本研究旨在评估匹兹堡大学医学中心(UPMC)卫生系统中出现缺血性卒中(包括隐源性卒中)的患者Lp(a)检查频率,以及Lp(a)与隐源性卒中的关系。方法查询UPMC 2010年至2020年40多家医院和200多个门诊点的电子医疗记录(EHR),以识别与非出血性缺血性卒中和隐源性卒中一致的ICD-9和ICD-10编码个体。此外,还获得了18 - 60岁、ICD-9或ICD-10编码为隐源性卒中、卒中、缺血性卒中或脑血管事件的患者中风后一年内的人口统计学、药物、合并症和血清学/生物标志物数据。排除标准包括年龄<;18或>;60岁或出血性中风史。结果14689例患者符合本研究的纳入标准。男性8395例(57.1%),女性6294例(42.8%)。基于ICD-9和ICD-10诊断代码的缺血性卒中患者为6386例(43.4%),基于ICD-9和ICD-10诊断代码的隐源性卒中患者为8303例(56.5%)。值得注意的是,根据ICD-9和ICD-10诊断代码,有1262人(8.6%)发生过短暂性脑缺血发作;这一诊断仅包括在隐源性卒中中。只有132人(0.9%)检测了Lp(a):缺血性卒中患者59人(0.9%),隐源性卒中患者73人(0.9%)(p值0.78)。缺血性脑卒中患者Lp(a)均值为73.0 nmol/L(范围21.0 ~ 2370.0 nmol/L),隐源性脑卒中患者Lp(a)均值为44.0 nmol/L(范围17.0 ~ 174.0 nmol/L) (p值0.262)。结论:我们的研究表明,尽管NLA的社会建议普遍进行Lp(a)检测,但在农村和城市地区的大型卫生系统中,Lp(a)在高危卒中人群中的检测仍然不足。考虑到这一人群的数量较少,本研究正在进行的前瞻性研究旨在评估Lp(a)在隐源性卒中患者中的作用。
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
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. 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.
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