Characteristics of patients with lipoprotein(a) assessment: a health insurance claims database analysis

Abstract

Abstract Background Elevated lipoprotein(a) (Lp(a)) is an inherited risk factor for cardiovascular disease. Testing for Lp(a) in primary care is recommended by current ESC guidelines to identify persons at risk. We aimed to report contemporary trends in Lp(a) testing in Germany and subsequent changes in treatment strategies and patient's outcome over time. Methods and results An observational, retrospective, anonymized claims data analysis was performed on a database with 4 million patients, representative of the German population in the years 2015 to 2018. Patients were eligible when no Lp(a) test was documented in the year prior to the index date/quarter (time point of the first documented Lp(a) test) and if the patient data was available for at least 1 year before and after the Lp(a) test or until death, whichever came first. In a cross-sectional analysis, Lp(a) test rates in the selected database population increased from 0.25% (n=7,432) in 2015 to 0.34% (n=10,257) in 2018. About 57.8% of the tested population was female. Higher test rates were observed in women especially in younger age groups. A subgroup analysis of patients with previous atherosclerotic cardiovascular disease (ASCVD) revealed overall higher Lp(a) test rates (0.43% in 2015, 0.60% in 2018). In a longitudinal analysis, patients tested for Lp(a) and respective controls matched for age, gender and region, were followed for a maximum of four years. Out of 3,139,410 eligible patients, 36,609 (1.17%) were tested for Lp(a) over the study period at a mean age of 51.91 years and were meeting the inclusion criteria. In comparison to matched controls without Lp(a) test, patients tested for Lp(a) had more comorbidities and higher ASCVD risk. The Lp(a)-tested cohort and the control group had similar mortality rates (0.88 vs. 0.94 per 100 person-years (PY), p=0.21). However, total mortality was lower in patients with prior ASCVD and Lp(a) test compared to matched patients with prior ASCVD but no Lp(a) test (Rates: 2.30 vs. 3.64 per 100 PY, p<0.001). Importantly, the patients with Lp(a) test were treated with a higher number of cardiovascular medications, underwent more laboratory examinations, and had more frequent consultations by specialized physicians after the test. Conclusion Lp(a) testing is an indicator of more intensive diagnostic work-up and treatment. Less than 1% of the patients have been newly tested for Lp(a) in 2018. The data identify an opportunity to better characterize ASCVD risk by testing for Lp(a). Funding Acknowledgement Type of funding sources: None.