Viet Le, PA-C: Real-World Experience Measuring Lp(a)

In the last decade the emergence of new markers has transformed the management of patients with cardiovascular risk, including the revelations surrounding the risk associated with elevated levels of lipoprotein(a) [Lp(a)]. This emergence has been so notable it has led to the development of novel agents, such as pelacarsen and olpasiran.

However, as of the American College of Cardiology’s (ACC) 2023 Annual Scientific Session Together With the World Congress of Cardiology, there are no FDA-approved agents with an indication for reducing Lp(a). Still, an inability to address Lp(a) as a risk factor does not diminish its value or utility for assessing cardiovascular risk in those with atherosclerotic cardiovascular disease. At ACC 2023, a study from Intermountain Healthcare provided insight into the institution’s real-world experience with Lp(a).

Using data collected within the network’s electronic health record from 2003-2021, investigators sought to provide an overview of the epidemiology, relationship to ASCVD risk factors, and clinical outcomes in a real-world setting. For the purpose of analysis, patients were stratified into subgroups based on Lp(a) levels, with thresholds of less than 30 mg/dL, 30-69 mg/dL, 70-99 mg/dL, and 100 or greater mg/dL used to define those with normal, mildly, moderately, and severely elevated Lp(a), respectively. The primary outcome of interest for the study was major adverse cardiovascular events, which included death, myocardial infarction, stroke, and peripheral arterial disease.

From electronic health records, investigators obtained information related to 5996 Lp(a) tests in 5028 individuals. Of these 5996 tests, 65.7% had Lp(a) in the normal range, 17.5% had Lp(a) in the mildly elevated range, 7.9% had Lp(a) in the moderately elevated range, and 8.9% had Lp(a) in the severely elevated range. Initial analyses indicated elevated Lp(a) levels were only modestly associated with other characteristics, including coronary artery disease history, dyslipidemia, and lipid-lowering.

Analysis of outcomes indicated 912 major adverse cardiovascular events occurred during the study, with Lp(a) levels greater than 30 mg/dL associated with a 19% increased risk of major adverse cardiovascular events in adjusted analyses (HR, 1.19; P=.01).

For more on the institution’s real-world experience with Lp(a), our editorial team sat down with study investigator Viet Le, PA-C, associate professor of research at Intermountain Healthcare and president of the Academy of Physician Associates in Cardiology.

References:

1. Anderson J, May H, Le V, et al. MEASURING LIPOPROTEIN(A) IN CLINICAL PRACTICE: EPIDEMIOLOGY, RELATIONSHIP TO ATHEROSCLEROTIC CARDIOVASCULAR (ASCVD) RISK FACTORS, AND CLINICAL OUTCOMES IN A REAL-WORLD EXPERIENCE. J Am Coll Cardiol. 2023 Mar, 81 (8_Supplement) 1634. https://doi.org/10.1016/S0735-1097(23)02078-8