Division of Cardiology Duke University Hospital Durham NC USA.
Duke Clinical Research Institute Durham NC USA.
J Am Heart Assoc. 2024 Nov 5;13(21):e035610. doi: 10.1161/JAHA.124.035610. Epub 2024 Nov 4.
Lipoprotein (a) is an independent risk factor for atherosclerotic cardiovascular disease. However, lipoprotein (a) testing remains variable and it is unclear what factors influence testing and if testing changes clinical management.
A retrospective study using electronic medical record data from 5 health systems identified an atherosclerotic cardiovascular disease cohort divided into those with and without a lipoprotein (a) test between 2019 and 2021. Baseline characteristics and lipid-lowering therapy patterns were assessed. Multivariable regression modeling was used to determine factors associated with lipoprotein (a) testing. Among 595 684 patients with atherosclerotic cardiovascular disease, only 2587 (0.4%) were tested for lipoprotein (a). Those who were older or Black individuals were less likely to have lipoprotein (a) testing, while those with familial hypercholesterolemia, ischemic stroke/transient ischemic attack, peripheral artery disease, prior lipid-lowering therapy, or low-density lipoprotein cholesterol ≥130 mg/dL were more likely to be tested. Those with a lipoprotein (a) test, regardless of the lipoprotein (a) value, were more frequently initiated on any statin therapy (30.3% versus 10.6%, < 0.001), ezetimibe (7.65% versus 0.8%, < 0.001), or proprotein convertase substilisin/kexin type 9 inhibitor (6.7% versus 0.3%, < 0.001) compared with those without a test. Those with an elevated lipoprotein (a) level more frequently initiated ezetimibe (11.5% versus 5.9%, < 0.001) or proprotein convertase substilisin/kexin type 9 inhibitor (10.9% versus 4.8%, < 0.001).
Lipoprotein (a) testing in patients with atherosclerotic cardiovascular disease is infrequent, with evidence of disparities among older or Black individuals. Testing for lipoprotein (a), regardless of level, is associated with greater initiation of any lipid-lowering therapy, while elevated lipoprotein (a) is associated with greater initiation of nonstatin lipid-lowering therapy. There is a critical need for multidisciplinary and inclusive approaches to raise awareness for lipoprotein (a) testing, and its implications on management.
脂蛋白(a)是动脉粥样硬化性心血管疾病的独立危险因素。然而，脂蛋白(a)检测仍然存在差异，目前尚不清楚哪些因素会影响检测，以及检测是否会改变临床管理。
本研究使用来自 5 个医疗系统的电子病历数据进行回顾性研究，确定了一个 2019 年至 2021 年间患有动脉粥样硬化性心血管疾病且接受或未接受脂蛋白(a)检测的队列。评估了基线特征和降脂治疗模式。多变量回归模型用于确定与脂蛋白(a)检测相关的因素。在 595684 名患有动脉粥样硬化性心血管疾病的患者中，只有 2587 人（0.4%）接受了脂蛋白(a)检测。年龄较大或为黑人的患者不太可能接受脂蛋白(a)检测，而患有家族性高胆固醇血症、缺血性卒中和短暂性脑缺血发作、外周动脉疾病、既往降脂治疗或低密度脂蛋白胆固醇≥130mg/dL 的患者更有可能接受检测。无论脂蛋白(a)值如何，接受脂蛋白(a)检测的患者更频繁地开始使用任何他汀类药物治疗（30.3%比 10.6%，<0.001）、依折麦布（7.65%比 0.8%，<0.001）或前蛋白转化酶枯草溶菌素/kexin 9 抑制剂（6.7%比 0.3%，<0.001），而未接受检测的患者则不然。脂蛋白(a)水平升高的患者更频繁地开始使用依折麦布（11.5%比 5.9%，<0.001）或前蛋白转化酶枯草溶菌素/kexin 9 抑制剂（10.9%比 4.8%，<0.001）。
在患有动脉粥样硬化性心血管疾病的患者中，脂蛋白(a)检测并不常见，而且在年龄较大或为黑人的患者中存在差异。检测脂蛋白(a)，无论水平如何，与更频繁地开始使用任何降脂治疗相关，而脂蛋白(a)升高与更频繁地开始使用非他汀类降脂治疗相关。迫切需要采取多学科和包容性的方法来提高对脂蛋白(a)检测的认识及其对管理的影响。
