Optimizing lipoprotein(a) testing for immediate clinical impact in primary prevention

Area of Science:

• Cardiovascular disease prevention
• Lipidology
• Public health screening

Background:

• Lipoprotein(a) [Lp(a)] measurement is recommended for all adults but underutilized.
• Pragmatic strategies are needed to enhance the clinical utility of Lp(a) testing.
• Primary prevention settings require optimized approaches for Lp(a) assessment.

Purpose of the Study:

• To evaluate pragmatic strategies for Lp(a) testing to maximize immediate clinical impact on lipid-lowering treatment (LLT) eligibility.
• To assess the utility of self-reported data as a pre-screening tool for elevated Lp(a).
• To determine how Lp(a) testing's impact on LLT eligibility varies by age and sex.

Main Methods:

• Analysis of 24,994 individuals aged 50-65 from the Swedish Cardiopulmonary BioImage Study (SCAPIS).
• Evaluation of self-reported data for predicting elevated Lp(a) (≥50 mg/dL) using ROC-AUC.
• Assessment of LLT eligibility based on ESC/EAS guidelines incorporating Lp(a) levels, stratified by age and sex.

Main Results:

• Self-reported data demonstrated poor predictive accuracy for elevated Lp(a) (ROC-AUC 0.54).
• Incorporating Lp(a) testing increased LLT eligibility from 11.3% to 19.6%.
• The number needed to screen (NNS) to identify one additional LLT-eligible individual was lowest for men aged 50-60 (≈10-15) and women ≥55 (<20 at 55, <10 at 65), but high for younger women (NNS >50).

Conclusions:

• Self-reported data are unreliable for identifying individuals with elevated Lp(a).
• Lp(a) testing significantly increases LLT eligibility, particularly in specific age and sex groups.
• Targeted Lp(a) screening in men ≥50 and women ≥55 years maximizes immediate clinical utility as an interim strategy.