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Low prevalence of testing for apolipoprotein B and lipoprotein (a) in the real world
Dana J Murdock1, Keran Moll1, Robert J Sanchez1
1Regeneron Pharmaceuticals, Inc., Tarrytown, NY, USA (Murdock, Moll, Sanchez, Gu, Fazio, Geba), Center for Academic Medicine, Department of Medicine/Division of Cardiovascular Medicine, Stanford University School of Medicine, Palo Alto, CA, USA (Rodriguez).
Insights
In 2019, only 38% of insured US adults received a lipid panel test, with less than 1% tested for Apolipoprotein B (ApoB) or lipoprotein (a) (Lp[a]). These cardiovascular disease risk markers are underutilized despite guidelines recommending their use.
Area of Science:
- Cardiovascular disease risk assessment
- Clinical lipidology
- Health services research
Background:
- Apolipoprotein B (ApoB) and lipoprotein (a) (Lp[a]) are established predictors of cardiovascular disease (CVD) risk.
- Current guidelines recommend ApoB and Lp(a) testing alongside standard lipid panels for comprehensive CVD risk assessment.
- US guidelines for ApoB and Lp(a) testing have evolved and show some variation among expert committees.
Purpose of the Study:
- To estimate the number of insured individuals in the USA who underwent testing for any component of a lipid panel, or for ApoB and/or Lp(a) in 2019.
- To assess the prevalence of lipid testing and specific biomarker testing among insured US adults.
Main Methods:
- A cross-sectional analysis of four US claims data sources (Medicaid, Medicare, commercial insurance) was conducted.
- Prevalence estimates were standardized by age, sex, payor, and region to the 2019 US population.
- A cohort analysis of the Optum claims database described the clinical profile of patients receiving lipid testing between 2019 and 2021.
Main Results:
- In 2019, 38% of insured US adults received at least one component of a lipid panel test.
- Testing rates for lipid panels were significantly higher in adults aged ≥65 years (62%) compared to younger adults (31%).
- Testing for ApoB and/or Lp(a) constituted less than 1% of all lipid panel testing; testing increased with age and comorbidities.
Conclusions:
- The uptake of ApoB and Lp(a) testing remains very low among insured US adults, despite their importance in CVD risk assessment.
- Guideline-issuing agencies should consider developing educational campaigns to promote the more frequent use of tests beyond the standard lipid panel.
- Increased utilization of ApoB and Lp(a) testing is warranted to improve cardiovascular risk stratification and management.
Objective:
Apolipoprotein B (ApoB) and lipoprotein (a) (Lp[a]) are predictors of cardiovascular disease (CVD) risk; therefore, current recommendations for CVD risk assessment and management advocate that patients receive testing for ApoB and Lp(a) in addition to the standard lipid panel. However, US guidelines around ApoB and Lp(a) testing have evolved over time and vary slightly by expert committee. The objective of this analysis was to estimate the number of insured individuals in the USA who received any component of a lipid test, or ApoB and/or Lp(a) testing, during 2019.
Methods:
We conducted a cross-sectional analysis to estimate the prevalence of any component of a lipid test, ApoB, and/or Lp(a) in the USA using four different claim data sources (including Medicaid, Medicare, and commercially insured enrollees). Prevalence estimates were age-, sex-, payor-, and region-standardized to the 2019 US Annual Social and Economic Supplement of the Current Population Survey. We also described the clinical profile of patients who received lipid testing between 2019 and 2021 (cohort analysis) in Optum claims database. Enrollees were grouped into four non-mutually exclusive cohorts based on their completion of any component of the lipid panel, ApoB, Lp(a), or ApoB and Lp(a).
Results:
In the prevalence cohort, over a third (38 %) of insured adults in the USA underwent testing for any component of a lipid panel in 2019. This proportion was higher for individuals aged ≥65 years compared to younger adults (62% vs 31 %). The proportion of ApoB and Lp(a) testing represented only <1 % of testing for any component of a lipid panel. In the cohort analysis, we found that lipid testing increased with age and comorbidities.
Conclusion:
These data should be considered by guideline-issuing agencies and organizations to develop education campaigns encouraging more frequent use of tests beyond the standard lipid panel.
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