Evaluating elevated lipoprotein(a) clinical care impact in an academic health center

Elevated lipoprotein(a) [Lp(a)] is associated with atherosclerotic cardiovascular disease (ASCVD). Nevertheless, Lp(a) is a poorly addressed ASCVD risk factor.

Evaluate the impact of elevated Lp(a) on clinical decision-making of known ASCVD risk factors and consideration of aspirin for primary prevention of cardiovascular disease.

We extracted data of patients who underwent Lp(a) testing from January 1, 2019, to December 31, 2023. We obtained patient and provider characteristics. Multivariable logistic regression was used to evaluate the association between elevated Lp(a) levels and therapy intensification, defined as intensification of statin or initiation of new lipid-lowering therapy, antihypertensive, antiplatelet, or antihyperglycemic agents.

A total of 530 patients had at least 1 Lp(a) measurement. Most were women (54.5%) with a mean age of 54 (41-67) and a mean body mass index (BMI) of 30 (24-36). The most common races were White (72.6%), Asian (9.2%), and Black (8.1%), while the most common ethnicity was Hispanic (10.8%). The most common comorbidities were hyperlipidemia (78.9%), hypertension (53.0%), obesity (40.4%), ASCVD (28.5%), and family history of ASCVD (22.6%). Cardiology (43.6%) and primary care (39.4%) were the most common specialties ordering Lp(a). Those with elevated Lp(a) were 3.5 times more likely to have therapy intensification (95% CI: 2.34-5.41; P < 0.001). In multivariable models, patients with intensified treatment were more likely to have a higher BMI (adjusted odds ratio [aOR] = 1.07 [<1.01-1.14]), and those with public insurance were less likely to receive therapy intensification (aOR = 0.29 [0.10-0.82]).

Our study shows that elevated Lp(a) was associated with therapy intensification. Greater efforts to increase awareness about this risk factor are needed.