Gomez Sofia E, Furst Adam, Chen Tania, Din Natasha, Maron David J, Heidenreich Paul, Kalwani Neil, Nallamshetty Shriram, Ward Jonathan H, Lozama Anthony, Sandhu Alexander, Rodriguez Fatima
Division of Cardiovascular Medicine, Department of Medicine, Stanford University, Stanford, CA, United States.
Palo Alto Veterans Affairs Healthcare System, Palo Alto, CA, United States.
Am J Prev Cardiol. 2024 Sep 23;20:100872. doi: 10.1016/j.ajpc.2024.100872. eCollection 2024 Dec.
Lipoprotein (a) [Lp(a)] is a causal, genetically-inherited risk amplifier for atherosclerotic cardiovascular disease (ASCVD). Practice guidelines increasingly recommend broad Lp(a) screening among various populations to optimize preventive care. Corresponding changes in testing rates and population-level detection of elevated Lp(a) in recent years has not been well described.
Using Veterans Affairs electronic health record data, we performed a retrospective cohort study evaluating temporal trends in Lp(a) testing and detection of elevated Lp(a) levels (defined as greater than 50 mg/dL) from January 1, 2014 to December 31, 2023 among United States Veterans without prior Lp(a) testing. Testing rates were stratified based on demographic and clinical factors to investigate possible drivers for and disparities in testing: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability.
Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023, while the proportion of elevated Lp(a) levels remained stable. Factors associated with higher likelihood of Lp(a) testing over time were a history of ASCVD, Asian race, and residing in neighborhoods with less social vulnerability.
Despite a 9-fold increase in Lp(a) testing among US Veterans over the last decade, the overall testing rate remains extremely low. The steady proportion of Veterans with elevated Lp(a) over time supports the clinical utility of testing expansion. Efforts to increase testing, especially among Veterans living in neighborhoods with high social vulnerability, will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.
脂蛋白(a) [Lp(a)]是动脉粥样硬化性心血管疾病（ASCVD）的一种因果性、基因遗传性风险增强因素。实践指南越来越多地建议在各类人群中广泛开展Lp(a)筛查，以优化预防保健。近年来检测率以及人群层面Lp(a)升高的检出情况的相应变化尚未得到充分描述。
利用退伍军人事务部电子健康记录数据，我们开展了一项回顾性队列研究，评估2014年1月1日至2023年12月31日期间，未进行过Lp(a)检测的美国退伍军人中Lp(a)检测及Lp(a)水平升高（定义为大于50 mg/dL）的检出情况的时间趋势。根据人口统计学和临床因素对检测率进行分层，以调查检测的可能驱动因素和差异：年龄、性别、种族和族裔、ASCVD病史以及社区社会脆弱性。
全国范围内，Lp(a)检测从2014年每10,000名符合条件的退伍军人1次检测（558次检测）增加到2023年每10,000名9次检测（4,440次检测），而Lp(a)水平升高的比例保持稳定。随着时间推移，与Lp(a)检测可能性较高相关的因素包括ASCVD病史、亚裔种族以及居住在社会脆弱性较低的社区。
尽管在过去十年中美国退伍军人的Lp(a)检测增加了9倍，但总体检测率仍然极低。随着时间推移，Lp(a)升高的退伍军人比例保持稳定，这支持了扩大检测的临床实用性。随着针对Lp(a)的新型治疗方法问世，努力增加检测，尤其是在社会脆弱性高的社区居住的退伍军人中增加检测，对于减少新出现的差异将很重要。
