Characterization of Lipoprotein(a) Measurement in a Large US Healthcare Dataset

Abstract

Lead Author's Financial Disclosures Nothing to disclose. Study Funding Family Heart Foundation. Background/Synopsis Elevated lipoprotein(a) [Lp(a)] is a well-recognized, independent risk factor for atherosclerotic cardiovascular disease (ASCVD) that is estimated to be present in 20% of the general population according to an NLA 2019 Scientific Statement, "Use of Lipoprotein(a) in Clinical Practice: A Biomarker Whose Time Has Come." Nonetheless, this genetic lipoprotein is rarely assessed. Objective/Purpose To characterize individuals receiving Lp(a) measurement and their providers using real-world data within the Family Heart Foundation integrated dataset of Americans screened or treated for ASCVD. Methods A cohort of individuals with at least one Lp(a) measurement and sufficient healthcare data was identified within an extensive dataset of >112 million individuals with laboratory data and diagnostic, procedural, and prescription claims from 2012-2019. Demographics (mean +/- standard deviation), ASCVD history, and healthcare provider at time of Lp(a) measurement were characterized. Probable familial hypercholesterolemia (FH) status was determined using a validated machine learning model. Results Lp(a) was rarely measured; 0.3% (n=335,726) of individuals had at least one Lp(a) measurement; they were aged 59.9 +/- 39.7 years, female (52.5%), Black (7.8%), Hispanic (7.1%), White (53.6%), and Other/Unknown (31.5%). Risk factors included hypertension (53.7%), hyperlipidemia (50.6%), and diabetes (24.6%). Cardiovascular history included ASCVD-only (29.1%), probable FH with ASCVD (1.2%), probable FH without ASCVD (1.7%), diagnosed FH with ASCVD (0.4%), diagnosed FH without ASCVD (0.6%), or no ASCVD or FH (70.8%). A small number of healthcare providers (n=629 of 810,119; <0.1%) were responsible for ordering the Lp(a) lab tests for 50% of individuals with a measurement; these providers most frequently specialized in internal medicine (26%), family medicine (23%), and internal medicine/CVD (14%), or were Physician Assistants & Advanced Practice Nursing Providers/Nurse Practitioner/Family (5%). Within this classification system, lipidology was not represented as a separate specialty. Conclusions Measurement of Lp(a) was rare within a large US healthcare dataset. Individuals who had Lp(a) assessed were older and had ASCVD risk factors; 31% had ASCVD. Ordering Lp(a) was concentrated within a very small number of all healthcare providers. Additional research is needed to characterize the barriers and facilitators related to ordering Lp(a) by healthcare providers for individuals with ASCVD and/or risk factors. Nothing to disclose.