Eidensohn Yehuda, Bhatla Anjali, Ding Jie, Blumenthal Roger S, Martin Seth S, Marvel Francoise A
Ciccarone Center for the Prevention of Cardiovascular Disease, Division of Cardiology, Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, Maryland, United States.
Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, Maryland, United States.
Am J Prev Cardiol. 2024 Jun 19;19:100686. doi: 10.1016/j.ajpc.2024.100686. eCollection 2024 Sep.
Elevated lipoprotein(a) [Lp(a)] is an independent, genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD). We evaluated the frequency of testing for elevated Lp(a) and subsequent management at the Johns Hopkins Hospital, a large academic medical center, over a 5-year period.
The Johns Hopkins Hospital (JHH) electronic medical record was queried to identify patients with an encounter between 2017 and 2021, either with established ASCVD or at increased risk, defined as being on any lipid lowering medication or having LDL-C ≥ 190 mg/dL. The frequency of Lp(a) testing and of elevated levels were identified for each year.
Among 111,350 unique adult patients, 2,785 (2.5 %) had at least one Lp(a) test. Patients with Lp(a) testing, compared to those without testing, were younger (mean age 56 years vs. 66 years), more often female (49 % vs. 44 %), Black (24.7 % vs. 24.6 %) or "other" race/ethnicity (12 % vs 10 %), and had higher LDL-C levels (median 118 vs. 91 mg/dL; < 0.001). The number and frequency of Lp(a) testing increased from 167 (0.57 %) in 2017 to 1155 (5.67 %) in 2021. Lp(a) levels were abnormal in 43.4 % of patients (moderate [75-125 nmol/L]: 10.3 %, high [126-600 nmol/L]: 32.2 %, severe [>600 nmol/L]: 0.9 %). Among 920 patients with high or severe Lp(a) levels, 200 (22 %) had a subsequent referral to cardiology or lipid specialist, and 180 (20 %) had a new lipid-lowering medication prescribed in the subsequent 18 months.
Based on a single-center experience, the frequency of incident Lp(a) testing among increased-risk patients was low but increased significantly over 5-years, likely due to Lipid Clinic referrals with reflex Lp(a) testing and greater awareness about this risk factor. Future work should target appropriate population based Lp(a) testing strategies and clinical decision-making regarding risk management once Lp(a) elevation is diagnosed.
脂蛋白(a)[Lp(a)]升高是动脉粥样硬化性心血管疾病(ASCVD)的一个独立的、由基因决定的危险因素。我们评估了在一家大型学术医疗中心约翰霍普金斯医院，5年期间检测Lp(a)升高的频率以及后续管理情况。
查询约翰霍普金斯医院(JHH)的电子病历，以识别2017年至2021年间有就诊记录的患者，这些患者患有已确诊的ASCVD或属于高危人群，高危定义为正在服用任何降脂药物或低密度脂蛋白胆固醇(LDL-C)≥190mg/dL。确定每年Lp(a)检测的频率和升高水平的频率。
在111350名成年患者中，2785名(2.5%)至少进行了一次Lp(a)检测。与未检测的患者相比，进行Lp(a)检测的患者更年轻(平均年龄56岁对66岁)，女性更多(49%对44%)，黑人更多(24.7%对24.6%)或属于“其他”种族/族裔(12%对10%)，且LDL-C水平更高(中位数118对91mg/dL；P<0.001)。Lp(a)检测的数量和频率从2017年的167例(0.57%)增加到2021年的1155例(5.67%)。43.4%的患者Lp(a)水平异常(中度[75-125nmol/L]：10.3%，高度[126-600nmol/L]：32.2%，重度[>600nmol/L]：0.9%)。在920例Lp(a)水平高或重度升高的患者中，200例(22%)随后被转诊至心脏病科或脂质专科，180例(20%)在随后18个月内新开了降脂药物。
基于单中心经验，高危患者中Lp(a)检测的发生率较低，但在5年期间显著增加，这可能是由于脂质门诊转诊并进行反射性Lp(a)检测以及对该危险因素的认识提高。未来的工作应针对基于适当人群的Lp(a)检测策略以及一旦诊断出Lp(a)升高时关于风险管理的临床决策。
