Lipoprotein(a) Testing Patterns in a Large Health System

Area of Science:

• Cardiology
• Clinical Practice
• Biomarkers

Background:

• Lipoprotein (a) [Lp(a)] is a known risk factor for atherosclerotic cardiovascular disease (ASCVD).
• Emerging targeted therapies for Lp(a) necessitate understanding its testing patterns in clinical practice.

Purpose of the Study:

• To characterize the patterns of Lp(a) testing within a large academic health system.
• To compare patient demographics and subsequent lipid-lowering therapy (LLT) initiation between Lp(a) testing and low-density lipoprotein cholesterol (LDL-C) testing alone.

Main Methods:

• Retrospective analysis of electronic health record (EHR) data from 2014 to 2019.
• Comparison of 1,296 patients with Lp(a) test results to date-matched controls with LDL-C assessment only.
• Analysis of ordering provider characteristics and LLT initiation within 12 months post-testing.

Main Results:

• Patients undergoing Lp(a) testing were more likely to have a history of early-onset myocardial infarction/ischemic stroke and multiple cardiovascular events.
• Neurology and psychiatry were the most frequent specialties ordering Lp(a) tests, with a higher proportion of inpatient testing compared to LDL-C tests.
• Significantly increased initiation of all types of LLT was observed after Lp(a) testing compared to LDL-C testing.

Conclusions:

• Lp(a) testing is primarily utilized in patients consistent with clinical guidelines, particularly those with early ASCVD onset or multiple cardiovascular events.
• Lp(a) testing is associated with more intensive lipid-lowering therapy in the subsequent year.
• Further research is required to understand Lp(a) testing across broader patient populations.