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Antibody Profiling by Luciferase Immunoprecipitation Systems LIPS

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Lipoprotein(a) Testing Patterns in a Large Health System.

Michelle Kelsey¹, Courtney Page², Brooke Alhanti²

¹Division of Cardiology, Department of Medicine, Duke University Hospital, Durham, NC; Duke Clinical Research Institute, Durham, NC.

The American Journal of Cardiology

|July 2, 2021

Summary

Lipoprotein (a) [Lp(a)] testing is increasingly used in patients with atherosclerotic cardiovascular disease (ASCVD), especially those with early onset or multiple events. Lp(a) testing is linked to more aggressive lipid-lowering therapy initiation.

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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.