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. 2021 Aug 15:153:43-50.
doi: 10.1016/j.amjcard.2021.05.018. Epub 2021 Jun 29.

Lipoprotein(a) Testing Patterns in a Large Health System

Michelle Kelsey  1 , Courtney Page  2 , Brooke Alhanti  2 , Shannon L Rhodes  3 , Shia T Kent  3 , Eric Peterson  4 , Neha Pagidipati  5
Affiliations

Lipoprotein(a) Testing Patterns in a Large Health System

Michelle Kelsey et al. Am J Cardiol. .

Abstract

Lipoprotein (a) [Lp(a)] is associated with increased risk of atherosclerotic cardiovascular disease (ASCVD). As directed therapy for Lp(a) emerges, it is important to understand patterns of Lp(a) testing in routine clinical practice. We set out to characterize Lp(a) testing across a large academic health system. Using electronic health record (EHR) data from 2014 to 2019, we compared patients who underwent Lp(a) testing to date-matched peers who had low density lipoprotein (LDL-C) assessment alone. We analyzed ordering provider characteristics and rates of initiation of new lipid lowering therapy (LLT) within 12 months after testing. Of 1,296 adults with Lp(a) test results, 629 (48.5%) had prior history of ASCVD and 667 (51.4%) did not. Compared with those with LDL-C testing alone, individuals who underwent Lp(a) testing were more like to have a myocardial infarction or ischemic stroke at a young age and multiple prior cardiovascular events. Though the majority of Lp(a) tests were ordered in outpatient encounters, a higher proportion of Lp(a) tests compared with LDL-C tests were performed in the inpatient setting. Neurology and psychiatry were the most common specialty to order Lp(a) tests in our cohort. There was a significantly increased initiation of LLT after Lp(a) testing compared with LDL-C testing across all medication types. Consistent with guidelines, Lp(a) testing is used in those with early onset ASCVD, and among those with multiple cardiovascular events. Lp(a) testing is associated with more aggressive LLT in following year. Further research is needed to characterize Lp(a) testing across larger populations.

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Conflict of interest statement

Disclosures The authors declare the following financial interests/personal relationships which may be considered as potential competing interests: Neha Pagidipati reports financial support was provided by Amgen, INC.

Figures

Figure 1.
Figure 1.
(A)Patient Flow for Lp(a) Cohort. (B)Patient Flow for LDL-C Cohort. Abbreviations: Lipoprotein (a), Lp(a) Abbreviations: Calculated Low Density Lipoprotein, LDL-C
Figure 1.
Figure 1.
(A)Patient Flow for Lp(a) Cohort. (B)Patient Flow for LDL-C Cohort. Abbreviations: Lipoprotein (a), Lp(a) Abbreviations: Calculated Low Density Lipoprotein, LDL-C
Figure 2.
Figure 2.
Range of Lp(a) Values by ASCVD status *ASCVD includes prior history of coronary artery disease, myocardial infarction, coronary artery bypass, percutaneous coronary intervention, peripheral artery disease, lower extremity amputation, claudication, carotid artery stenosis, peripheral revascularization, cerebrovascular accident or ischemic stroke
See this image and copyright information in PMC

References

    1. Steyrer E, Durovic S, Frank S, Giessauf W, Burger A, Dieplinger H, Zechner R, Kostner GM. The role of lecithin: cholesterol acyltransferase for lipoprotein (a) assembly. Structural integrity of low density lipoproteins is a prerequisite for Lp(a) formation in human plasma. J Clin Invest 1994;94:2330–2340. - PMC - PubMed
    1. Willeit P, Ridker PM, Nestel PJ, Simes J, Tonkin AM, Pedersen TR, Schwartz GG, Olsson AG, Colhoun HM, Kronenberg F, Drechsler C, Wanner C, Mora S, Lesogor A, Tsimikas S. Baseline and on-statin treatment lipoprotein(a) levels for prediction of cardiovascular events: individual patient-data meta-analysis of statin outcome trials. Lancet 2018;392:1311–1320. - PubMed
    1. Clarke R, Peden JF, Hopewell JC, Kyriakou T, Goel A, Heath SC, Parish S, Barlera S, Franzosi MG, Rust S, Bennett D, Silveira A, Malarstig A, Green FR, Lathrop M, Gigante B, Leander K, de Faire U, Seedorf U, Hamsten A, Collins R, Watkins H, Farrall M. Genetic variants associated with Lp(a) lipoprotein level and coronary disease. N Engl J Med 2009;361:2518–2528. - PubMed
    1. Erqou S, Thompson A, Di Angelantonio E, Saleheen D, Kaptoge S, Marcovina S, Danesh J. Apolipoprotein(a) isoforms and the risk of vascular disease: systematic review of 40 studies involving 58,000 participants. J Am Coll Cardiol 2010;55:2160–2167. - PubMed
    1. Loscalzo J, Weinfeld M, Fless GM, Scanu AM. Lipoprotein(a), fibrin binding, and plasminogen activation. Arteriosclerosis 1990;10:240–245. - PubMed

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