Eidensohn Yehuda, O'Rourke Paul
Internal Medicine, Johns Hopkins Bayview Medical Center, Baltimore, USA.
General Internal Medicine, Johns Hopkins University School of Medicine, Baltimore, USA.
Cureus. 2025 May 10;17(5):e83859. doi: 10.7759/cureus.83859. eCollection 2025 May.
Lipoprotein(a) (Lp(a)) is an independent risk factor for the development of atherosclerotic cardiovascular disease (ASCVD) and is recognized in guidelines as a risk-enhancing factor favoring the more aggressive management of lipids. However, the clinical utilization of Lp(a) testing has been low, especially among internal medicine providers. Methods: We designed a 30-minute presentation for internal medicine residents that included a general overview of ASCVD risk assessment, differences between Lp(a) and regular low-density lipoprotein cholesterol (LDL-C), and examples of how elevated Lp(a) can change clinical management. Resident confidence in ordering and interpreting Lp(a) was assessed by pre- and post-surveys. Data on Lp(a) ordering practices were abstracted from the electronic medical record for the three months prior to and after the presentation. Results: The presentation was administered to 22 interns in the fall of the 2024-2025 academic year and was associated with an increase in participant confidence, with mean survey scores increasing from 10 to 24 out of a maximum score of 25 (p<0.001). Lp(a) tests ordered by participants increased from seven (15% of all residents' Lp(a) orders) in the three months prior to 28 (44% of all residents' Lp(a) orders) in the subsequent three months (p=0.008). Discussion: Lp(a) testing is an underutilized adjunct to ASCVD risk stratification. We developed a brief presentation that was associated with increased confidence regarding the topic of Lp(a) testing as well as changes in practice, as evidenced by increased Lp(a) orders. These encouraging single-center results can help inform future educational efforts on the topic of ASCVD prevention.
An Lp(a) curriculum for internal medicine residents showed promise in addressing the lack of awareness of Lp(a) testing. Further research is needed to assess the generalizability and retention of this curriculum.
脂蛋白(a)（Lp(a)）是动脉粥样硬化性心血管疾病（ASCVD）发生发展的独立危险因素，在指南中被视为一种风险增强因素，支持对血脂进行更积极的管理。然而，Lp(a)检测的临床应用率一直较低，尤其是在内科医生中。方法：我们为内科住院医师设计了一个30分钟的讲座，内容包括ASCVD风险评估的概述、Lp(a)与常规低密度脂蛋白胆固醇（LDL-C）的区别，以及Lp(a)升高如何改变临床管理的实例。通过讲座前后的调查评估住院医师开具和解读Lp(a)检测的信心。从讲座前三个月和讲座后三个月的电子病历中提取Lp(a)检测的医嘱数据。结果：在2024-2025学年秋季，该讲座面向22名实习生进行，与参与者信心的提高相关，平均调查得分从满分25分中的10分提高到24分（p<0.001）。参与者开具的Lp(a)检测从讲座前三个月的7次（占所有住院医师Lp(a)检测医嘱的15%）增加到随后三个月的28次（占所有住院医师Lp(a)检测医嘱的44%）（p=0.008）。讨论：Lp(a)检测是ASCVD风险分层中未得到充分利用的辅助手段。我们开展了一个简短的讲座，该讲座与对Lp(a)检测主题的信心增加以及实践变化相关，Lp(a)检测医嘱增加就是证明。这些令人鼓舞的单中心结果有助于为未来关于ASCVD预防主题的教育工作提供参考。结论：针对内科住院医师的Lp(a)课程在解决对Lp(a)检测认识不足的问题上显示出前景。需要进一步研究来评估该课程的可推广性和持续性。
