Implementation and Assessment of a Lipoprotein(a) Curriculum for Internal Medicine Residents: A Longitudinal Study

Lipoprotein(a) (Lp(a)) is an independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD) and is recognized in guidelines as a risk-enhancing factor favoring the more aggressive management of lipids. However, the clinical utilization of Lp(a) testing has been low, especially among internal medicine providers.  Methods: We designed a 30-minute presentation for internal medicine residents that included a general overview of ASCVD risk assessment, differences between Lp(a) and regular low-density lipoprotein cholesterol (LDL-C), and examples of how elevated Lp(a) can change clinical management. Resident confidence in ordering and interpreting Lp(a) was assessed by pre- and post-surveys. Data on Lp(a) ordering practices were abstracted from the electronic medical record for the three months prior to and after the presentation.  Results: The presentation was administered to 22 interns in the fall of the 2024-2025 academic year and was associated with an increase in participant confidence, with mean survey scores increasing from 10 to 24 out of a maximum score of 25 (p<0.001). Lp(a) tests ordered by participants increased from seven (15% of all residents' Lp(a) orders) in the three months prior to 28 (44% of all residents' Lp(a) orders) in the subsequent three months (p=0.008).  Discussion: Lp(a) testing is an underutilized adjunct to ASCVD risk stratification. We developed a brief presentation that was associated with increased confidence regarding the topic of Lp(a) testing as well as changes in practice, as evidenced by increased Lp(a) orders. These encouraging single-center results can help inform future educational efforts on the topic of ASCVD prevention.

An Lp(a) curriculum for internal medicine residents showed promise in addressing the lack of awareness of Lp(a) testing. Further research is needed to assess the generalizability and retention of this curriculum.