Trends and experience with lipoprotein(a) testing in a large academic medical center

Abstract

Funding

Kaneka Corporation

Background/Synopsis

Evidence has grown around the relationship between lipoprotein(a) [Lp(a)] and cardiovascular disease risk. The 2024 focused update on Lp(a) from the National Lipid Association recognizes elevated plasma Lp(a) as an important independent, causal risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis.

Objective/Purpose

We hypothesize that there has been slow adoption of recommended Lp(a) screening and aim to understand current testing rates and trends within a large healthcare system, especially in higher risk patients.

Methods

Within a university-based health system, a large data extraction model was used to identify all patients who had undergone Lp(a) testing. Relevant high-risk patient populations, including all those with known histories of coronary artery disease, cerebral vascular accident, peripheral arterial disease, aortic stenosis, LDL-C >190, coronary artery calcium score >100, and familial hypercholesterolemia (FH) across the system were identified using diagnosis and procedural codes.

Results

In a health system with an estimated number of 4,553,100 unique patients, Lp(a) testing has been done 3,361 times on 1,976 unique patients between 12/2013 and 11/2023, representing approximately 0.04% of patients. Since 2016, Lp(a) measurement has increased on average by 23.6% year-over-year, as detailed in Figure 1, with rates of Lp(a) testing in each specific comorbidity group outlined in Figure 2. Most notably, patients with FH have a significantly higher rate of Lp(a) testing (25.7%) while patients with known aortic stenosis have a significantly lower rate of Lp(a) testing (0.7%) despite recommendations.

Conclusions

In a large academic medical center, Lp(a) measurement remains low, though with notable increase in just the last few years. Each of the patient comorbidity groups outlined have a higher rate of Lp(a) testing than the general population but remain significantly lower than recommended by recent guidelines regarding Lp(a) testing. The exception is patients with a diagnosis of FH, who have significantly higher rates of testing, likely influenced by following in a specialty lipid clinic. Our group postulates that the number of patients undergoing Lp(a) testing will exponentially increase, prompting the need for clearer guidelines for the management of each subpopulation of patients, notably as novel therapeutic agents directed at Lp(a) become approved and the experience with apheresis for Lp(a) continues to grow.