Comparison of Lp(a) assessment in patients with atherosclerotic cardiovascular disease between office-based cardiologists and general practitioners

Abstract

Abstract Background Elevated lipoprotein(a) (Lp(a)) levels are a major risk factor that contribute to the development of ASCVD. Different guidelines for the treatment of patients with hypercholesterolemia are available in Germany. The German Cardiac Society recognized the 2019 ESC/EAS guideline for the management of dyslipidemia and endorses the measurement of Lp(a) at least once in a lifetime to identify those with very high inherited Lp(a) levels >180 mg/dL (>430 nmol/L) . The Nationale Versorgungsleitlinie, however, does not recommend testing of Lp(a). Methods and Objectives LipidSnapshot is a joint research project consisting of two parts. Part 1 is a prospective, non-interventional multicenter research project at office-based cardiologists (OBCs). Data from 1500 adults with known coronary artery disease, peripheral artery disease, prior myocardial infarction and/or ischemic stroke are collected from selected 49 OBCs. The second part is a retrospective, aggregated analysis of anonymous electronic medical records of 82.375 adult outpatient ASCVD patients documented by general practices (GPs) obtained from the IQVIA Disease Analyzer (note: 54% do not provide information on Lp(a) data to IQVIA). Availability of Lp(a) tests and lipid-lowering therapies (LLTs) in ASCVD patients with available LDL-C values within a 12-month period (July 2022-June 2023) were assessed. One of the objectives of LipidSnapshot is to compare the proportion of Lp(a) assessments in ASCVD patients documented by OBCs and GPs and to evaluate gender-, age- and LLTs-related differences in Lp(a) availability in patients documented by OBCs compared to GPs. Results Patients treated by OBCs were on average 72.4 (standard deviation (SD) 10.0) years old and 75.8 % were male while patients in the IQVIA dataset were on average 73.0 (SD 13.2) years old and 60.5% were male. The age distribution was comparable between both specialties. OBCs documented Lp(a) in 20.3% of their ASCVD patients, while only 3.0% of ASCVD patients documented by GPs had Lp(a) values documented. The testing rates in male and female patients were comparable between both specialties (OBC: 19.5 vs. 22.9%; GPs: 3.4 vs. 2.5%). For both specialties, Lp(a) testing rate was higher in younger patients compared to older patients (Table 1) and in patients treated with PCSK9-inhibitors (monoclonal antibodies, inclisiran), either as monotherapy or in combination with statins and/or other LLTs (ezetimibe, bempedoic acid, bile acid sequestrants) (Table 2). Conclusion The first snapshot revealed differences in healthcare provision of GPs compared to selected OBCs with lower rates of identification of higher risk patients treated by GPs in Germany.Age-related differences in Lp(a)LLT-related differences in Lp(a)