A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice

Koschinsky, Marlys L.; Bajaj, Archna; Boffa, Michael B.; Dixon, Dave L.; Ferdinand, Keith C.; Gidding, Samuel S.; Gill, Edward A.; Jacobson, Terry A.; Michos, Erin D.; Safarova, Maya S.; Soffer, Daniel E.; Taub, Pam R.; Wilkinson, Michael J.; Wilson, Don P.; Ballantyne, Christie M.

doi:10.1016/j.jacl.2024.03.001

Cited by 33 publications

(8 citation statements)

References 80 publications

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“…Second, similar to several additional observational cohort studies [ 12 , 13 ], NHANES III utilized a mass-based (mg/dL) assay for quantifying Lp(a), which may be prone to measurement bias at the extremes of Lp(a) values [14] . While both mass (mg/dL) and particle (nmol/L) measurements are acceptable, particle-based measurement is preferred and efforts are ongoing to facilitate laboratory standardization [15] . Information on aspirin use was only collected at study baseline and also self-reported, subject to recall bias and misclassification [16] .…”

Section: Discussionmentioning

confidence: 99%

Aspirin use for primary prevention among US adults with and without elevated Lipoprotein(a)

Razavi,

Richardson,

Coronado

et al. 2024

American Journal of Preventive Cardiology

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Section: Discussionmentioning

confidence: 99%

Aspirin use for primary prevention among US adults with and without elevated Lipoprotein(a)

Razavi,

Richardson,

Coronado

et al. 2024

American Journal of Preventive Cardiology

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“…The new 2024 update to the 2019 NLA statement 12 for use of Lp(a) in clinical practice, for the first time in the US, recommends measuring Lp(a) in all. NLA recognizes individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) as high risk, which acknowledges that Lp(a) is associated with an increased incidence of ASCVD even in the absence of a family history of heart disease.…”

Section: Discussionmentioning

confidence: 99%

“…The goal is to identify individuals and family members who would benefit from more intensive disease prevention, including LDL-C lowering 11 . The most recent update to the National Lipid Association (NLA) statement recommends, for the first time in the US, to measure Lp(a) in all adults once in a lifetime 12 . The aims of our study are to assess how racial/ethnic and socioeconomic factors impact Lp(a) ordering practices in a large urban academic institution.…”

Section: Introductionmentioning

confidence: 99%

Race/ethnicity and socioeconomic status affect the assessment of lipoprotein(a) levels in clinical practice

Pavlyha,

Li,

Crook

et al. 2024

Preprint

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Background and Objective: High Lp(a) levels are a risk factor for ASCVD, however Lp(a) ordering in clinical practice is low. This study examines how race/ethnicity and socioeconomic status influence Lp(a) ordering. Methods: This is a single center, retrospective study (2/1/2020-6/30/2023) using electronic medical records of adults with at least one ICD-10 diagnosis of ASCVD or resistant hyperlipidemia (LDL-C >160 mg/dL on statin therapy). We evaluated Lp(a) level differences among racial/ethnic groups and sexes. We also assessed associations between diagnosis type, diagnosis number, age at diagnosis, race, socioeconomic score (based on zip codes), public health coverage and presence of Lp(a) orders. Results: 4% of our cohort (N=56,833) had an Lp(a) order (17.3% Hispanic, 8.7% non-Hispanic Black, 47.5% non-Hispanic White and, 27% Asian/others). Non-Hispanic Black and Hispanic patients had lower rates of Lp(a) orders (0.17%, 0.28%, respectively) when compared to non-Hispanic White patients (2.35%), p<0.001, however, their median Lp(a) levels were higher. Individuals belonging to deprived socioeconomic groups or on Medicaid, were less likely to have an Lp(a) order (RR=0.39, p<0.001 and RR=0.40, p<0.001 respectively). Certain diagnoses (carotid stenosis, family history of ASCVD and FH) and multiple diagnoses (>2) resulted in more Lp(a) orders compared to those with only one diagnosis (p<0.001). Conclusions: Lp(a) ordering is low in patients with ASCVD. Non-Hispanic Black and Hispanic patients at risk are less likely to have an Lp(a) order. Individuals residing in socioeconomically deprived neighborhoods and on Medicaid are also less like have Lp(a) order. Lp(a) orders depend on the type and number of patients' diagnoses.

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“…They also state that it is reasonable to check Lp(a) in those who have family history of premature ASCVD and to reclassify on the border of risk categories in order to determine treatment strategies [ 54 ]. Other societies such as the National Lipid Association and Canadian Cardiovascular Society take a more aggressive approach in screening, recommending that everyone should obtain an Lp(a) measurement as part of initial lipid screening [ 55 , 56 ]. Just as no major guidelines recommend screening for PAD in the setting of elevated Lp(a) levels, there are conversely no recommendations for screening Lp(a) in the setting of PAD.…”

Section: Screeningmentioning

confidence: 99%

The Role of Lipoprotein(a) in Peripheral Artery Disease

Pavlatos,

Kalra

2024

Biomedicines

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Lipoprotein(a) is a low-density-lipoprotein-like particle that consists of apolipoprotein(a) bound to apolipoprotein(b). It has emerged as an established causal risk factor for atherosclerotic cardiovascular disease, stroke, and aortic valve stenosis through multifactorial pathogenic mechanisms that include inflammation, atherogenesis, and thrombosis. Despite an estimated 20% of the global population having elevated lipoprotein(a) levels, testing remains underutilized due to poor awareness and a historical lack of effective and safe therapies. Although lipoprotein(a) has a strong association with coronary artery disease and cerebrovascular disease, its relationship with peripheral artery disease is less well established. In this article, we review the epidemiology, biology, and pathogenesis of lipoprotein(a) as it relates to peripheral artery disease. We also discuss emerging treatment options to help mitigate major adverse cardiac and limb events in this population.

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A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice

Cited by 33 publications

References 80 publications

Aspirin use for primary prevention among US adults with and without elevated Lipoprotein(a)

Aspirin use for primary prevention among US adults with and without elevated Lipoprotein(a)

Race/ethnicity and socioeconomic status affect the assessment of lipoprotein(a) levels in clinical practice

The Role of Lipoprotein(a) in Peripheral Artery Disease

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