Abstract 13909: Use of Advanced Lipoprotein Testing in Real-World Data: A Cross Sectional Study Across Multiple Health Systems

Abstract

Introduction: Per AHA guidelines, adults between 40-75 with borderline (5-7.5%) 10-year ASCVD risk (approximately 2.5% of this population in prior studies) should have the decision to start statin therapy personalized. Per AHA guidelines, elevated apolipoprotein B-100 (apoB) and elevated lipoprotein(a) (Lp(a)) are risk enhancing factors that may be considered in this decision. Hypothesis: We hypothesize that <10% of the estimated borderline 10-year ASCVD risk population between 40-75 years of age are tested for apo(B) or Lp(a). Methods: We performed a hypothesis-driven secondary analysis of a cross-sectional dataset of adults with LDL-c assessed in the most recent year of available data from 7 health systems participating in PaTH, a Partner Network in PCORnet. Participating sites reported summaries of demographics, diagnoses and lab testing for their health system populations as well as sub-cohorts of patients with prior ASCVD events, diabetes (DM), and a history of LDL > 190mg/dl. We evaluated the lifetime testing for apo(B) and Lp(a) in the whole population and subtracted out the testing in the high-risk cohorts. Results: From a population of 784,406 adults, we identified a cohort of 301,235 aged 40-75 without prior ASCVD event, DM, or LDL > 190. We estimated that 2.5% of this population (7,531) had borderline 10-year ASCVD risk. A total of 730 individuals were tested for apoB and 892 for Lp(a) across the entire non-high-risk cohort (0.2% and 0.3%). Assuming only the borderline risk group was tested, this represents testing rates of 9.7% for apoB and 11.8% for Lp(a), ranging across healthcare systems from 0-27% for apoB and 0-42% for Lp(a). Conclusions: Within the constraints of our population-based cross-sectional study, we found it plausible that >10% of the borderline-risk population utilized either apoB or Lp(a) testing for further risk stratification. Future work should be done to directly evaluate the use of these parameters in the borderline-risk population.