2014-2023 年美国退伍军人脂蛋白(a)检测的时间趋势

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS
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引用次数: 0

摘要

治疗领域新型生物标记物背景升高的脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病(ASCVD)的一个由基因决定的独立因果风险因素。多项当代临床实践指南都认可通过脂蛋白(a)检测来完善 ASCVD 风险分层,并指导高危患者的临床决策。我们利用退伍军人事务部的电子健康记录数据进行了一项回顾性队列研究,以评估 2014 年 1 月 1 日至 2023 年 12 月 31 日期间美国退伍军人脂蛋白(a)检测的时间趋势。我们确定了每年接受过初级保健或心脏病就诊、服用过有效药物且之前未进行过脂蛋白(a)检测的退伍军人。我们根据人口统计学和临床因素对检测率进行了分层:年龄、性别、种族和民族、ASCVD 病史以及疾病控制中心定义的邻里社会脆弱性指数 (SVI) 分数。SVI 包含就业、收入、拥挤程度和教育程度等变量,分数越高,表明脆弱性越大。我们使用三个具有临床意义的阈值对脂蛋白(a)水平升高进行分类:结果全国范围内的脂蛋白(a)检测从 2014 年的每 1 万名合格退伍军人 1 次(558 次)增加到 2023 年的每 1 万名退伍军人 9 次(4440 次)。虽然所有群体的检测率都有所上升,但随着时间的推移,ASCVD的流行与脂蛋白(a)检测率的上升密切相关(图)。与社会脆弱性低的人群相比,居住在社会脆弱性高的人群的检测率增加较少。亚裔退伍军人的检测率增幅最大,但其他种族和族裔群体的检测率增幅相似。结论我们发现,在过去十年中,美国退伍军人的脂蛋白(a)检测率增加了 9 倍,尤其是在患有 ASCVD 的退伍军人中,但总体检测率仍然极低。脂蛋白(a)升高的退伍军人比例保持稳定,这支持了扩大检测范围的临床效用。随着针对脂蛋白(a)的新型疗法的出现,努力增加对生活在社会脆弱性高的社区的退伍军人的检测对于减少新出现的差异非常重要。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
TEMPORAL TRENDS IN LIPOPROTEIN(A) TESTING AMONG UNITED STATES VETERANS FROM 2014-2023

Therapeutic Area

Novel Biomarkers

Background

Elevated lipoprotein(a) [Lp(a)] is a genetically-determined, independent, causal risk factor for atherosclerotic cardiovascular disease (ASCVD). Multiple contemporary clinical practice guidelines endorse Lp(a) testing to refine risk stratification for ASCVD and guide clinical decision-making among high-risk patients. Changes in rates of testing and detection of elevated Lp(a) over time have not been well described.

Methods

We performed a retrospective cohort study using Veterans Affairs electronic health record data to evaluate temporal trends in Lp(a) testing from January 1, 2014 to December 31, 2023 among United States Veterans. We identified Veterans in each year who had a primary care or cardiology visit, an active medication filled, and no prior Lp(a) testing. We stratified testing rates based on demographic and clinical factors: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability index (SVI) scores as defined by the Centers for Disease Control. The SVI incorporates variables such as employment, income, crowding, and education, with higher scores suggesting greater vulnerability. We classified elevated Lp(a) levels using three clinically meaningful thresholds: 50 mg/dL, 70 mg/dL and 90 mg/dL.

Results

Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023. While testing increased across all groups, prevalent ASCVD was strongly associated with an increase in Lp(a) testing over time (Figure). Rates of testing increased less among those residing in neighborhoods with high social vulnerability compared with low social vulnerability. Rates of testing increased most among Asian Veterans but similarly across other racial and ethnic groups. The percent of elevated tests across clinically meaningful thresholds has remained stable over time.

Conclusions

We found a 9-fold increase in Lp(a) testing among US Veterans over the last decade, particularly among those with ASCVD, but the overall rate remains extremely low. The proportion of Veterans with elevated Lp(a) has remained steady, supporting the clinical utility of testing expansion. Efforts to increase testing among Veterans living in neighborhoods with high social vulnerability will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.
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来源期刊
American journal of preventive cardiology
American journal of preventive cardiology Cardiology and Cardiovascular Medicine
CiteScore
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76 days
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