Lipoprotein(a) cascade screening in coronary artery disease

Area of Science:

• Cardiovascular Medicine
• Genetics
• Public Health Screening

Background:

• Elevated lipoprotein(a) [Lp(a)] is a significant risk factor for coronary artery disease (CAD).
• Cascade screening offers a potential strategy to identify individuals at genetic risk for CAD.
• Understanding the effectiveness of Lp(a)-based cascade screening is crucial for clinical implementation.

Purpose of the Study:

• To evaluate the effectiveness of cascade screening for elevated Lp(a) in relatives of patients with CAD.
• To determine the yield of identifying elevated Lp(a) in first-degree relatives (FDR) and second-degree relatives (SDR) based on the index patient's Lp(a) level.

Main Methods:

• Cascade screening was performed in FDR and SDR of index patients with CAD.
• Index patients were stratified into low, moderately elevated, and elevated Lp(a) groups.
• The proportion of relatives with elevated Lp(a) and participation rates were analyzed within each stratum.

Main Results:

• Out of 1120 invited relatives, 764 (68.2%) were screened.
• Elevated Lp(a) was found in 30.2% of FDR and 19.4% of SDR from index patients with elevated Lp(a), versus 6.2% and 5.6% from those with low Lp(a), respectively.
• Screening was more efficient when initiated from index patients with elevated Lp(a), requiring fewer relatives to be screened to identify one affected individual.

Conclusions:

• Cascade screening for elevated Lp(a) is a feasible strategy in a real-world setting for relatives of CAD patients.
• The effectiveness of cascade screening is significantly higher when the index patient has elevated Lp(a).
• This approach can efficiently identify at-risk relatives for further cardiovascular risk management.