Elevated lipoprotein(a) (Lp(a)) is an independent genetically determined risk factor for atherosclerotic cardiovascular disease (ASCVD), and its levels above 50 mg/dL affect 20–30% of the world’s population. Despite its therapeutic limitations, interest in Lp(a) is increasing due to its prognostic value and the emergence of targeted therapies. However, with the increase in guideline-based Lp(a) testing, clinicians’ responses to elevated concentrations remain unclear, especially in the absence of guideline-based treatment indications.
In a new study and presentation at the American College of Cardiology, researchers found that elevated Lp(a) was associated with earlier and more frequent initiation of preventive drug therapy. These response rates were modest in low-risk primary prevention study populations.
Specifically, nearly 80% of patients with elevated Lp(a) >50 mg/dL did not initiate lipid-lowering therapy in the absence of other ASCVD risk factors. Initiation of drugs that significantly lower “bad” LDL cholesterol (PCSK9 inhibitors) or aspirin is even less common, suggesting a selective rather than systematic response to elevated Lp(a). Taken together, these findings suggest that elevated Lp(a) appears to affect prescribing behavior only occasionally, and that behavior is consistent with previous reports.
Although currently not a standard indication for statin therapy alone, elevated Lp(a) is increasingly used by clinicians as a “risk enhancer” to guide more aggressive preventive measures, although this is often not standardized.
Sheila A. Barnard, MD, corresponding author, associate professor at Boston University Chobanian-Avedisyan School of Medicine
Researchers conducted a multicenter, retrospective, observational cohort study evaluating initiation of prophylactic drug therapy after Lp(a) measurement in approximately 15,000 patients at low risk for ASCVD. Lipid-lowering therapy was rarely initiated within 90 days of Lp(a) measurement, but was initiated more frequently in patients with elevated Lp(a) compared with patients without elevated Lp(a). PCSK9 inhibitor initiation was rare but more frequent in patients with elevated Lp(a). Similarly, aspirin initiation was rare but more frequent in patients with elevated Lp(a).
According to the researchers, these findings should not be interpreted as an indication that such prescribing is guideline-based. “Current recommendations recognize Lp(a) as a risk-increasing factor rather than a treatment target, and no treatments are approved solely for the purpose of increasing Lp(a). Our analysis describes contemporary practice rather than appropriate management,” added Bernard, who is also a cardiologist at Boston Medical Center.
The results of this survey are also posted online. American Journal of Preventive Cardiology.
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Boston University School of Medicine
