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. 2022 May:349:144-150.
doi: 10.1016/j.atherosclerosis.2022.01.022. Epub 2022 Jan 31.

Trends in testing and prevalence of elevated Lp(a) among patients with aortic valve stenosis

Harpreet S Bhatia  1 , Gary S Ma  1 , Adam Taleb  1 , Michael Wilkinson  1 , Andrew M Kahn  1 , Bruno Cotter  1 , Calvin Yeang  1 , Anthony N DeMaria  1 , Mitul P Patel  1 , Ehtisham Mahmud  1 , Ryan R Reeves  1 , Sotirios Tsimikas  2
Affiliations

Trends in testing and prevalence of elevated Lp(a) among patients with aortic valve stenosis

Harpreet S Bhatia et al. Atherosclerosis. 2022 May.

Abstract

Background and aims: Lipoprotein(a) [Lp(a)] is causally associated with aortic valve stenosis (AS) but Lp(a) testing among AS patients is not broadly incorporated into clinical practice. We evaluated trends in Lp(a) testing in an academic medical center.

Methods: Educational efforts and adding Lp(a) to the lipid panel on the electronic medical record (EMR) and pre-procedure order sets were used to increase awareness of Lp(a) as a risk factor in AS. Medical records at University of California San Diego Health (UCSDH) were analyzed from 2010 to 2020 to define the yearly frequency of first time Lp(a) testing in patients with diagnosis codes for AS or undergoing transcatheter aortic valve replacement (TAVR).

Results: Lp(a) testing for any indication increased over 5-fold from 2010 to 2020. A total of 3808 patients had a diagnosis of AS and 417 patients had TAVR. Lp(a) levels >30 mg/dL were present in 37% of AS and 35% of TAVR patients. The rates of Lp(a) testing in AS and TAVR were 14.0% and 65.7%, respectively. In AS, Lp(a) testing increased over time from 8.5% in 2010, peaking at 24.2% in 2017, and declining to 13.9% in 2020 (p < 0.001 for trend). Following implementation of EMR order-sets in 2016, Lp(a) testing in TAVR cases increased to a peak of 88.5% in 2018.

Conclusions: Elevated Lp(a) is prevalent in AS and TAVR patients. Implementation of educational efforts and practice pathways resulted in increased Lp(a) testing in patients with AS. This study represents a paradigm that may allow increased global awareness of Lp(a) as a risk factor for AS.

Keywords: Aortic stenosis; Lipids; Lipoprotein(a); Testing.

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Conflict of interest statement

Declaration of competing interest

ST is a co-inventor and receives royalties from patents owned by UCSD and is a co-founder and has an equity interest in Oxitope, Inc and its affiliates, Kleanthi Diagnostics, LLC and Covicept Therapeutics, Inc. ST has a dual appointment at UCSD and Ionis Pharmaceuticals. Although these relationships have been identified for conflict-of-interest management based on the overall scope of the project, the research findings included in this particular publication may not necessarily relate to the interests of the above companies. The terms of this arrangement have been reviewed and approved by the University of California, San Diego in accordance with its conflict-of-interest policies. ST has received research funding to UCSD from Novartis. The other co-authors have nothing to disclose.

Figures

Fig. 1.
Fig. 1.
Lp(a) testing at UCSD Health 2010–2020. The graph represents the yearly volume of unique Lp(a) testing for all indications at UCSD Health from 2010 to 2020. Unique tests per year increased over time, starting with 236 patients in 2010 and peaking at 1458 patients in 2019.
Fig. 2.
Fig. 2.
Frequency of Lp(a) testing among patients with AS by year. The graph represents the prevalence of Lp(a) testing among patients diagnosed with aortic stenosis by year. Prevalence of Lp(a) testing increased over time from 8.5% in 2010 to a peak of 24.2% in 2017 (p < 0.001 for trend by chi square testing).
Fig. 3.
Fig. 3.
Frequency of Lp(a) testing among patients with severe AS by year. The graph represents the prevalence of Lp(a) testing among patients diagnosed with severe aortic stenosis by at least one of three echo criteria. Prevalence of Lp(a) testing increased over time from 20.3% in 2016 to a peak of 46.2% in 2017 (p = 0.005 for trend by chi square testing).
Fig. 4.
Fig. 4.
Frequency of Lp(a) testing among TAVR patients by year. The graph represents the prevalence of Lp(a) testing among patients undergoing transcatheter aortic valve replacement. Prevalence of Lp(a) testing increased over time from 0.0% in 2013 to a peak of 88.5% in 2018 (p < 0.001 for trend by chi square testing).
See this image and copyright information in PMC

References

    1. Yeang C, Wilkinson MJ, Tsimikas S, Lipoprotein(a) and oxidized phospholipids in calcific aortic valve stenosis, Curr. Opin. Cardiol. 31 (2016) 440–450. - PMC - PubMed
    1. Gotoh T, Kuroda T, Yamasawa M, Nishinaga M, Mitsuhashi T, Seino Y, Nagoh N, Kayaba K, Yamada S, Matsuo H, Hosoe M, Itoh Y, Kawai T, Igarashi M, Shimada K, Correlation between lipoprotein(a) and aortic valve sclerosis assessed by echocardiography (the JMS Cardiac Echo and Cohort Study), Am. J. Cardiol. 76 (1995) 928–932. - PubMed
    1. Vongpromek R, Bos S, Ten Kate GJR, Yahya R, Verhoeven AJM, De Feyter PJ, Kronenberg F, Roeters Van Lennep JE, Sijbrands EJG, Mulder MT, Lipoprotein(a) levels are associated with aortic valve calcification in asymptomatic patients with familial hypercholesterolaemia, J. Intern. Med. 278 (2015) 166–173. - PubMed
    1. Thanassoulis G, Campbell CY, Owens DS, Smith JG, Smith AV, Peloso GM, Kerr KF, Pechlivanis S, Budoff MJ, Harris TB, Malhotra R, O’Brien KD, Kamstrup PR, Nordestgaard BG, Tybjaerg-Hansen A, Allison MA, Aspelund T, Criqui MH, Heckbert SR, Hwang SJ, Liu Y, Sjogren M, van der Pals J, Kalsch H, Muhleisen TW, Nothen MM, Cupples LA, Caslake M, Di Angelantonio E, Danesh J, Rotter JI, Sigurdsson S, Wong Q, Erbel R, Kathiresan S, Melander O, Gudnason V, O’Donnell CJ, Post WS, Group CECW, Genetic associations with valvular calcification and aortic stenosis, N. Engl. J. Med. 368 (2013) 503–512. - PMC - PubMed
    1. Kamstrup PR, Tybjærg-Hansen A, Nordestgaard BG, Elevated lipoprotein(a) and risk of aortic valve stenosis in the general population, J. Am. Coll. Cardiol. 63 (2014) 470–477. - PubMed

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