Hu Xingdi, Cristino Joaquim, Gautam Raju, Mehta Rina, Amari Diana, Heo Ji Haeng, Wang Siwei, Wong Nathan D
Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA.
EVERSANA, Hyderabad, Telangana, India.
Am J Prev Cardiol. 2023 Feb 23;14:100476. doi: 10.1016/j.ajpc.2023.100476. eCollection 2023 Jun.
Elevated lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease (ASCVD) and has no approved pharmacotherapies. Limited real-world data exists on the proportion of patients with available Lp(a) test results, characteristics of these patients, and their use of lipid lowering therapies (LLTs) for secondary prevention (SP) and primary prevention (PP) of ASCVD.
Patients with measured Lp(a) receiving LLTs for SP or PP of ASCVD were identified in the Optum Clinformatics® Data Mart database. Lp(a) distribution and LLT utilization including persistence and adherence were assessed. Logistic regression was used to assess the association between Lp(a) levels and low-density lipoprotein cholesterol (LDL-C) levels after index LLT, adjusting for baseline characteristics.
Overall, 2154 SP and 7179 PP patients met eligibility criteria. Of patients with available laboratory data, only 0.7% (SP) and 0.6% (PP) had Lp(a) test results. In the SP cohort, Lp(a) levels ≥125 nmol/L and ≥175 nmol/L were 26.4% and 17.6%, respectively, and the mean (SD) Lp(a) levels (overall SP cohort 90.4 [97.9] nmol/L) were highest in Black patients (123.4 [117.4]; <0.001). Statin monotherapy was the most frequently prescribed LLT in SP patients overall (89.4%). Median (interquartile range [IQR]) persistence of LLTs was 227 (91, 649) days and 33.6% achieved ≥80% proportion of days covered (PDC). Patients with Lp(a) ≥175 nmol/L had 2.1 times greater odds of having elevated LDL-C (≥70 mg/dL) post-LLT than those with Lp(a) <175 nmol/L ( = 0.031). Similar findings were observed in the PP population.
Lp(a) screening was rare. Elevated Lp(a) was observed in more than one-quarter of patients receiving LLTs, with the highest mean Lp(a) levels observed in Black patients. Low adherence to LLTs was prevalent and at least half of patients failed to achieve their respective LDL-C target thresholds despite treatment. Finally, high Lp(a) levels were associated with worse LDL-C control.
脂蛋白(a)[Lp(a)]升高是动脉粥样硬化性心血管疾病(ASCVD)的危险因素，且尚无获批的药物治疗方法。关于有Lp(a)检测结果的患者比例、这些患者的特征以及他们在ASCVD二级预防(SP)和一级预防(PP)中使用降脂治疗(LLT)的真实世界数据有限。
在Optum Clinformatics®数据集市数据库中识别接受LLT用于ASCVD的SP或PP且检测了Lp(a)的患者。评估Lp(a)分布和LLT使用情况，包括持续性和依从性。使用逻辑回归评估指数LLT后Lp(a)水平与低密度脂蛋白胆固醇(LDL-C)水平之间的关联，并对基线特征进行校正。
总体而言，2154例SP患者和7179例PP患者符合纳入标准。在有可用实验室数据的患者中，只有0.7%(SP)和0.6%(PP)有Lp(a)检测结果。在SP队列中，Lp(a)水平≥125 nmol/L和≥175 nmol/L的患者分别占26.4%和17.6%，黑人患者(123.4 [117.4];<0.001)的平均(标准差)Lp(a)水平(整个SP队列90.4 [97.9] nmol/L)最高。他汀类单药治疗是SP患者中最常开具的LLT(89.4%)。LLT的中位(四分位间距[IQR])持续时间为227(91,649)天，33.6%的患者达到≥80%的覆盖天数比例(PDC)。Lp(a)≥175 nmol/L的患者在LLT后LDL-C升高(≥70 mg/dL)的几率是Lp(a)<175 nmol/L患者的2.1倍( = 0.031)。在PP人群中观察到类似结果。
Lp(a)筛查很少见。在接受LLT的患者中，超过四分之一的患者Lp(a)升高，黑人患者的平均Lp(a)水平最高。LLT的低依从性普遍存在，尽管接受了治疗，但至少一半的患者未能达到各自的LDL-C目标阈值。最后，高Lp(a)水平与较差的LDL-C控制相关。
