EVALUATING LIPOPROTEIN(A) TESTING PATTERNS AND ASSOCIATED CLINICAL CARE IMPACT IN A LARGE ACADEMIC HEALTH CENTER

Abstract

Therapeutic Area

ASCVD/CVD Risk Factors

Background

Lipoprotein(a) [Lp(a)] is a strong culprit for cardiovascular disease (CVD) risk. Lp(a) promotes atherosclerosis by increasing vascular inflammation, atherogenesis, calcification and thrombosis. Despite this knowledge, Lp(a) testing remains infrequent and unrecognized. This project aims to understand the current Lp(a) testing patterns and the clinical care impact in a real-world setting, with the ultimate goal of improving testing and CVD risk mitigation.

Methods

Retrospective observational study of a diverse cohort from several clinics across the UConn Health Center from January 1^st, 2019 to June 31st, 2022. We obtained patients’ demographics, comorbidities, laboratory results, and medication initiation history as well as ordering provider demographics and specialty. A Fisher’s exact test was employed to evaluate the correlation between elevated Lp(a) levels and intensification of lipid-lowering therapy (LLT), initiation of anti-hypertensive agents, or GLP-1 receptor agonists (GLP-1 RAs).

Results

In our cohort of 215 patients, most were women (55%) with a mean age of 56 (43-69) and mean BMI of 30(24-36). Self-reported race and ethnicity were 73% White, 9 % African Americans, 8% Hispanic and 7% Asians. Most patients with an Lp(a) test had hyperlipidemia, hypertension, obesity or ASCVD. The majority of Lp(a) testing was ordered in the outpatient setting. Cardiology, primary care and neurology were the most common specialties ordering Lp(a) testing. Female providers were more likely to order testing than male counterparts. Among patients with Lp(a) test, 61.4% were normal (<75nmol/L or <30mg/dL), 11.6% were intermediate risk (75-125nmol/L or 30-50mg/dL) and 26.9% were high risk (≥125nmol/L or ≥50mg/dL). There was a strong correlation (p<0.001) between elevated Lp(a) and intensification of treatment. Additionally, patients with elevated Lp(a) were 8 times more likely (95% CI: 3.89-17.29) to have intensification of LLT, initiation of new anti-hypertensive agents or GLP-1 RAs.

Conclusions

Lp(a) remains an underrecognized, easily missed and poorly addressed CVD risk factor. Despite lack of current targeted therapy, our cohort showed that elevated Lp(a) was associated with aggressive CVD risk factor mitigation that is important to explore. Strategies to increase Lp(a) testing across disciplines should guide future implementation efforts.