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How should public health recommendations address Lp(a) measurement, a causative risk factor for cardiovascular

Alberico L Catapano1, Magdalena Daccord2, Elaine Damato3

  • 1Director Center for the Study of Atherosclerosis at Bassini Hospital University of Milan, Milan, Italy.

Atherosclerosis
|March 16, 2022
PubMed

Insights

Wider measurement of Lipoprotein (a) [Lp(a)], a key inherited risk factor for atherosclerotic cardiovascular disease (ASCVD), offers significant clinical and economic benefits today. Addressing barriers to Lp(a) testing is crucial for realizing these advantages.

Area of Science:

  • Cardiology
  • Clinical Chemistry
  • Health Economics

Background:

  • Elevated Lipoprotein (a) [Lp(a)] is an inherited, causal risk factor for atherosclerotic cardiovascular disease (ASCVD).
  • Understanding the clinical utility and economic impact of widespread Lp(a) measurement is essential for cardiovascular disease (CVD) management.
  • Current guidelines and awareness may limit the broader adoption of Lp(a) testing.

Purpose of the Study:

  • To investigate the clinical utility of measuring Lipoprotein (a) [Lp(a)] concentrations for patients.
  • To evaluate the economic benefits to healthcare systems and society of wider Lp(a) measurement.
  • To identify barriers to Lp(a) measurement uptake and propose solutions.

Main Methods:

  • A structured literature review was conducted to identify economic and health benefits and costs associated with Lp(a) measurement.
  • Potential barriers to Lp(a) testing uptake and solutions were identified.
  • Findings were discussed in an advisory board with experts and patient organizations.

Main Results:

  • Wider measurement of Lp(a) concentration provides clinical and economic benefits to patients, healthcare systems, and society, even before specific Lp(a)-lowering treatments are available.
  • Increased Lp(a) measurement uptake can support the development of crucial epidemiological data.
  • The study identified key barriers including perceived limited clinical value, lack of awareness, insufficient data on CV benefit, and technical/guideline/healthcare system issues.

Conclusions:

  • Addressing barriers such as perceived limited clinical value and lack of awareness is vital for increasing Lp(a) measurement uptake.
  • Collaboration between scientific communities and industry is needed to overcome technical and guideline challenges.
  • Policy interventions are crucial for national atherosclerotic cardiovascular disease (ASCVD) plans to recognize the importance of Lp(a) testing.
Abstract

Keywords:
Atherosclerotic cardiovascular disease (ASCVD)Barriers to measurement uptakeClinical benefitLipoprotein (a) [Lp(a)]Lp(a) measurementPolicy intervention

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