Lipoprotein(a) Testing Trends in a Large Academic Health System in the United States

Abstract

Background Despite its high prevalence and clinical significance, clinical measurement of lipoprotein(a) is rare but has not been systematically quantified. We assessed the prevalence of lipoprotein(a) testing overall, in those with various cardiovascular disease (CVD) conditions and in those undergoing cardiac testing across 6 academic medical centers associated with the University of California, in total and by year from 2012 to 2021. Methods and Results In this observational study, data from the University of California Health Data Warehouse on the number of individuals with unique lipoprotein(a) testing, unique CVD diagnoses (using International Classification of Diseases, Tenth Revision [ ICD‐10 ], codes), and other unique cardiac testing were collected. The proportion of total individuals, the proportion of individuals with a given CVD diagnosis, and the proportion of individuals with a given cardiac test and lipoprotein(a) testing any time during the study period were calculated. From 2012 to 2021, there were 5 553 654 unique adults evaluated in the University of California health system, of whom 18 972 (0.3%) had lipoprotein(a) testing. In general, those with lipoprotein(a) testing were more likely to be older, men, and White race, with a greater burden of CVD. Lipoprotein(a) testing was performed in 6469 individuals with ischemic heart disease (2.9%), 836 with aortic stenosis (3.1%), 4623 with family history of CVD (3.3%), 1202 with stroke (1.7%), and 612 with coronary artery calcification (6.1%). For most conditions, the prevalence of testing in the same year as the diagnosis of CVD was relatively stable, with a small upward trend over time. Lipoprotein(a) testing was performed in 10 753 individuals (1.8%) who had lipid panels, with higher rates with more specialized testing, including coronary computed tomography angiography (6.8%) and apolipoprotein B (63.0%). Conclusions Lipoprotein(a) testing persists at low rates, even among those with diagnosed CVD, and remained relatively stable over the study period.

Evaluation of a Machine Learning-guided Strategy for Elevated Lipoprotein(a) Screening in Health Systems

“…18 Despite the clinical significance of elevated Lp(a) and current guideline recommendations for once-in-a-lifetime universal screening for this condition, only 0.4% have undergone Lp(a) testing which aligns with the reported measures from other health systems and claims databases. [15][16][17] Adherence to guideline recommendations in realworld clinical practice remains a challenge in different domains of medicine and cardiology with implementation science being an active area of interest and research. 19,20 The feasibility of deploying ARISE within health systems suggests its potential as an effective strategy to bridge this gap and promote widespread Lp(a) testing and case identification, thereby enhancing care quality and patient outcomes on a larger scale.…”

“…This could stem from healthcare providers preferentially ordering Lp(a) tests for high-risk patients or those with recurrent cardiovascular events. [15][16][17] Moreover, the gradual dissemination of new medical practices and the potential future availability of targeted therapeutics may catalyze the broader adoption of universal Lp(a) screening. However, there is a wide gap between existing knowledge and its practical application, wherein ARISE implementation within health systems represents a promising avenue to address this disconnect.…”

“…These individuals should subsequently undergo rigorous cardiovascular risk management, e.g., statins, proprotein convertase subtilisin/kexin type 9 inhibitors, and lifestyle modifications. 6,[15][16][17][21][22][23][24][25] Additionally, novel Lp(a)-targeted medications are being developed and tested in randomized clinical trials. [9][10][11][12][13][14] Nevertheless, inadequate testing challenges the timely recruitment of the participants.…”

“…[7][8][9][10][11][12][13][14] Despite these developments, fewer than 0.5% of the patients undergo Lp(a) testing. [15][16][17] To address the limited testing of Lp(a) in contemporary practice, we have developed and validated a novel machine learning model to increase the yield of Lp(a) testing using six features, including ASCVD history, use of statins, use of anti-hypertensive medications, serum low-density lipoprotein cholesterol (LDL-C), serum high-density lipoprotein cholesterol (HDL-C), and serum triglycerides. 18 The model, Algorithmic Risk Inspection for Screening Elevated Lp(a) (ARISE), demonstrated a consistent reduction of the number-needed-to-test to find one case with elevated Lp(a) by more than 50% in four multinational cohorts.…”

Recommendations of the Experts of the Polish Cardiac Society (PCS) and the Polish Lipid Association (PoLA) on the diagnosis and management of elevated lipoprotein(a) levels

“…A study of more than 5 million adults at six academic medical centres affiliated with the University of California in the United States found that the frequency of Lp(a) determination remains very low at 0.3%, with a 4% prevalence among patients with cardiovascular diseases [ 11 ]. A study including all adults (4.6 million) registered with the largest health organisation in Israel showed that only 0.1% had their Lp(a) levels tested between 2015 and 2021 [ 12 ].…”