A multi-method study on GPs' perspectives on Lipoprotein(a) as an actionable cardiovascular risk factor

Elevated Lipoprotein(a) [Lp(a)] is a common hypercholesterolaemia disorder that requires continuity of care from primary care doctors, yet elevated Lp(a) is a highly neglected condition globally. Here, we aimed to explore general practitioners' (GPs') perspectives and practices on the detection and management of elevated Lp(a) and to assess the impact of LILAC-for-Lp(a) training on GPs' confidence in managing Lp(a).

A total of 18 general practitioners (GPs) participated in the focus group discussions. Pre- and post-education questionnaires were administered to 50 GPs to assess changes in perceptions after education.

The median age of the focus group participants was 55 years, and 33% were women. Only two GPs were routinely testing for Lp(a) in patients at high cardiovascular risk. The analysis generated eight categories under four themes: (i) current context, (ii) patient selection for testing, (iii) barriers and enablers, and (iv) patient acceptance of testing. Although the GPs agreed that elevated Lp(a) levels should ideally be included in routine cardiovascular risk assessment, the critical barriers to integrating Lp(a) testing were the absence of nationally approved management pathways, out-of-pocket costs, low public awareness, and major knowledge gaps among healthcare providers. Key strategies include improving training and launching a national implementation programme with cost subsidies. Pre- and post-forum questionnaires collected from 50 GPs showed that the LILAC-for-Lp(a) educational framework had positively changed their perspectives on testing Lp(a) and improved their confidence in managing Lp(a) (p < 0.001).

In conclusion, the barriers to testing and managing Lp(a) among GPs include an unclear management pathway and insufficient training. However, the LILAC-for- Lp(a) educational framework helped shift the GPs' mindsets positively.