Abstract
Introduction: Lipoprotein (a) [Lp(a)] is an emerging target for atherosclerotic cardiovascular disease (ASCVD) with racial/ethnic differences that may link with ASCVD. Compared to non-Hispanic White (NHW) individuals, Asian and Black individuals have high Lp(a) levels. We evaluated diverse racial/ethnic reporting and representation in high impact studies of Lp(a) and ASCVD that inform major Lp(a) scientific statements. Methods: We reviewed the 2022 American Heart Association (AHA) Scientific Statement on Lipoprotein (a) and the 2019 Scientific Statement from the National Lipid Association (NLA) on the Use of Lipoprotein (a) in Clinical Practice for all cited observational studies or trials of Lp(a) and ASCVD. For studies of the same cohort, only the one with the largest sample size was included. Meta-analyses were excluded to avoid duplication. Manuscripts and supplements were systematically reviewed for participant race/ethnicity data. Participation (%) was pooled across studies for overall representation. In a sub-analysis of US studies, pooled representation was compared with 2020 US Census data. Results: A total of 58 studies met inclusion criteria. Only 33 (57%) reported any race/ethnicity. Reporting studies (participant n=701859) had 92% NHW, 2.6% Black, 0.6% Hispanic, 3.2% Asian, and <0.1% American Indian/Alaskan Native or Native Hawaiian/Pacific Islander participants. No Lp(a) studies disaggregated Hispanic subgroups and 5 disaggregated Asian subgroups. In US studies, Hispanic and Asian representation was lower than 2020 US Census data (Fig). Conclusions: High impact studies of Lp(a) and ASCVD underreport and rarely disaggregate participant race/ethnicity and have low overall Black, Hispanic, and Asian representation. Among US studies, Hispanic and Asian groups are underrepresented versus 2020 Census data. Efforts are needed to improve diverse study race/ethnicity reporting and representation for this emerging therapeutic target.
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