Pavlyha Marianna, Li Yihao, Crook Sarah, Anderson Brett R, Reyes-Soffer Gissette
medRxiv. 2024 May 14:2024.05.14.24307362. doi: 10.1101/2024.05.14.24307362.
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.
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.
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).
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.
高脂蛋白(a)[Lp(a)]水平是动脉粥样硬化性心血管疾病（ASCVD）的一个危险因素，然而在临床实践中检测Lp(a)的情况并不常见。本研究探讨种族/民族和社会经济地位如何影响Lp(a)检测。
这是一项单中心回顾性研究（2020年2月1日至2023年6月30日），使用至少有一项国际疾病分类第十版（ICD-10）诊断为ASCVD或难治性高脂血症（他汀类治疗时低密度脂蛋白胆固醇>LDL-C>160mg/dL）的成年人的电子病历。我们评估了不同种族/民族群体和性别之间的Lp(a)水平差异。我们还评估了诊断类型、诊断数量、诊断时年龄、种族、社会经济评分（基于邮政编码）、公共卫生覆盖范围与Lp(a)检测之间的关联。
我们队列中的4%（N=56,833）进行了Lp(a)检测（西班牙裔占17.3%，非西班牙裔黑人占8.7%，非西班牙裔白人占47.5%，亚洲人/其他种族占27%）。与非西班牙裔白人患者（2.35%）相比，非西班牙裔黑人和西班牙裔患者进行Lp(a)检测的比例较低（分别为0.17%、0.28%），p<0.001，然而，他们的Lp(a)中位数水平较高。属于社会经济贫困群体或参加医疗补助计划的个体进行Lp(a)检测的可能性较小（相对风险RR=0.39，p<0.001；RR=0.40，p<0.001）。与仅有一项诊断的患者相比，某些诊断（颈动脉狭窄、ASCVD家族史和家族性高胆固醇血症）和多项诊断（>2项）导致更多的Lp(a)检测（p<0.001）。
ASCVD患者中Lp(a)检测率较低。有风险的非西班牙裔黑人和西班牙裔患者进行Lp(a)检测的可能性较小。居住在社会经济贫困社区且参加医疗补助计划的个体进行Lp(a)检测的可能性也较小。Lp(a)检测取决于患者诊断的类型和数量。
