2015年至2023年全球脂蛋白(a)检测趋势。

Global lipoprotein (a) testing trends from 2015 to 2023.

作者信息

Hanif Muhammad, Khan Laibah Arshad, Kulkarni Anandita, Bhatia Harpreet S, Wilkinson Michael J, Rashid Ahmed Mustafa, Chew Nicholas W S, Banerjee Subhash, Butler Javed, Shapiro Michael D, Khan Muhammad Shahzeb

机构信息

Department of Medicine, SUNY Upstate Medical University, Syracuse, NY.

Department of Medicine, University of Mississippi Medical Center, Jackson, MS.

出版信息

Am Heart J. 2025 Nov;289:171-179. doi: 10.1016/j.ahj.2025.06.010. Epub 2025 Jun 21.

DOI:10.1016/j.ahj.2025.06.010

PMID:40550301

Abstract

BACKGROUND

Lipoprotein (a) [Lp(a)] is a known cardiovascular disease risk factor. Recent guidelines recommend Lp(a) testing once in all individuals, especially in those with premature cardiovascular disease, and family history of cardiovascular disease. Emerging Lp(a) lowering therapies have the potential to mitigate this risk. However, the current global trends in Lp(a) testing remain unknown. This study aimed to evaluate global patterns in Lp(a) testing over the past decade, including trends in high-risk and key demographic subgroups.

METHODS

We conducted a retrospective cohort study using the TriNetX Global Collaborative Network and identified comorbidities using the International Classification of Disease, Tenth Revision, and Clinical Modification (ICD-10-CM) codes. Study population included adults age (≥18 years) who underwent Lp(a) testing between January 2015 and December 2023. We assessed annual trends in Lp(a) testing overall and in high-risk subgroups, including coronary artery disease (CAD), peripheral artery disease (PAD), ischemic stroke, heart failure (HF), family history of CAD, carotid artery stenosis, and aortic stenosis.

RESULTS

141 million patients from 144 healthcare organizations were included. Lp(a) testing was conducted in 175,853 patients, with a mean age of 59.0 ± 16.9 years, 50% women and 63% white adults. Overall Lp(a) testing increased nominally from 0.009% in 2015 to 0.032% in 2023. Among different high-risk subgroups, Lp(a) testing was also considerably low and only had a modest gradual increase between 2015 and 2023 (CAD: 0.24%-0.85%; PAD: 0.20%-0.42%; Ischemic stroke: 0.61%-0.71%; HF: 0.19%-0.51%; Family history of CAD: 0.24%-1.29%; Carotid artery stenosis: 0.37%-0.90%; Aortic stenosis: 0.18%-0.56%). In 2023, all subgroups had <1% Lp(a) testing, except those with family history of CAD.

CONCLUSION

Global Lp(a) testing rates remain low overall and in high-risk subgroups, emphasizing the need for education and implementation of guideline-recommended testing and risk stratification.

摘要

背景

脂蛋白(a)[Lp(a)]是一种已知的心血管疾病风险因素。最近的指南建议对所有个体进行一次Lp(a)检测，尤其是那些患有早发性心血管疾病以及有心血管疾病家族史的个体。新出现的降低Lp(a)的疗法有可能降低这种风险。然而，目前全球Lp(a)检测的趋势仍不清楚。本研究旨在评估过去十年全球Lp(a)检测的模式，包括高危和关键人口亚组的趋势。

方法

我们使用TriNetX全球合作网络进行了一项回顾性队列研究，并使用国际疾病分类第十次修订本及临床修订版(ICD-10-CM)编码确定合并症。研究人群包括2015年1月至2023年12月期间接受Lp(a)检测的成年人(≥18岁)。我们评估了Lp(a)检测总体以及高危亚组的年度趋势，这些高危亚组包括冠状动脉疾病(CAD)、外周动脉疾病(PAD)、缺血性中风、心力衰竭(HF)、CAD家族史、颈动脉狭窄和主动脉狭窄。

结果

纳入了来自144个医疗机构的1.41亿患者。175853名患者进行了Lp(a)检测，平均年龄为59.0±16.9岁，50%为女性，63%为成年白人。总体Lp(a)检测率从2015年的0.009%名义上增加到2023年的0.032%。在不同的高危亚组中，Lp(a)检测率也相当低，在2015年至2023年期间仅略有逐渐增加(CAD：0.24%-0.85%；PAD：0.20%-0.42%；缺血性中风：0.61%-0.71%；HF：0.19%-0.51%；CAD家族史：0.24%-1.29%；颈动脉狭窄：0.37%-0.90%；主动脉狭窄：0.18%-0.56%)。在2023年，除了有CAD家族史的亚组外，所有亚组的Lp(a)检测率均<1%。