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Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study

OBJECTIVE: Elevated lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease (ASCVD) and has no approved pharmacotherapies. Limited real-world data exists on the proportion of patients with available Lp(a) test results, characteristics of these patients, and their use of li...

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Autores principales: Hu, Xingdi, Cristino, Joaquim, Gautam, Raju, Mehta, Rina, Amari, Diana, Heo, Ji Haeng, Wang, Siwei, Wong, Nathan D.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Elsevier 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10015179/
https://www.ncbi.nlm.nih.gov/pubmed/36936405
http://dx.doi.org/10.1016/j.ajpc.2023.100476
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author Hu, Xingdi
Cristino, Joaquim
Gautam, Raju
Mehta, Rina
Amari, Diana
Heo, Ji Haeng
Wang, Siwei
Wong, Nathan D.
author_facet Hu, Xingdi
Cristino, Joaquim
Gautam, Raju
Mehta, Rina
Amari, Diana
Heo, Ji Haeng
Wang, Siwei
Wong, Nathan D.
author_sort Hu, Xingdi
collection PubMed
description OBJECTIVE: Elevated lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease (ASCVD) and has no approved pharmacotherapies. Limited real-world data exists on the proportion of patients with available Lp(a) test results, characteristics of these patients, and their use of lipid lowering therapies (LLTs) for secondary prevention (SP) and primary prevention (PP) of ASCVD. METHODS: Patients with measured Lp(a) receiving LLTs for SP or PP of ASCVD were identified in the Optum Clinformatics® Data Mart database. Lp(a) distribution and LLT utilization including persistence and adherence were assessed. Logistic regression was used to assess the association between Lp(a) levels and low-density lipoprotein cholesterol (LDL-C) levels after index LLT, adjusting for baseline characteristics. RESULTS: Overall, 2154 SP and 7179 PP patients met eligibility criteria. Of patients with available laboratory data, only 0.7% (SP) and 0.6% (PP) had Lp(a) test results. In the SP cohort, Lp(a) levels ≥125 nmol/L and ≥175 nmol/L were 26.4% and 17.6%, respectively, and the mean (SD) Lp(a) levels (overall SP cohort 90.4 [97.9] nmol/L) were highest in Black patients (123.4 [117.4]; p<0.001). Statin monotherapy was the most frequently prescribed LLT in SP patients overall (89.4%). Median (interquartile range [IQR]) persistence of LLTs was 227 (91, 649) days and 33.6% achieved ≥80% proportion of days covered (PDC). Patients with Lp(a) ≥175 nmol/L had 2.1 times greater odds of having elevated LDL-C (≥70 mg/dL) post-LLT than those with Lp(a) <175 nmol/L (p = 0.031). Similar findings were observed in the PP population. CONCLUSIONS: Lp(a) screening was rare. Elevated Lp(a) was observed in more than one-quarter of patients receiving LLTs, with the highest mean Lp(a) levels observed in Black patients. Low adherence to LLTs was prevalent and at least half of patients failed to achieve their respective LDL-C target thresholds despite treatment. Finally, high Lp(a) levels were associated with worse LDL-C control.
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spelling pubmed-100151792023-03-16 Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study Hu, Xingdi Cristino, Joaquim Gautam, Raju Mehta, Rina Amari, Diana Heo, Ji Haeng Wang, Siwei Wong, Nathan D. Am J Prev Cardiol Original Research Contribution OBJECTIVE: Elevated lipoprotein(a) [Lp(a)] is a risk factor for atherosclerotic cardiovascular disease (ASCVD) and has no approved pharmacotherapies. Limited real-world data exists on the proportion of patients with available Lp(a) test results, characteristics of these patients, and their use of lipid lowering therapies (LLTs) for secondary prevention (SP) and primary prevention (PP) of ASCVD. METHODS: Patients with measured Lp(a) receiving LLTs for SP or PP of ASCVD were identified in the Optum Clinformatics® Data Mart database. Lp(a) distribution and LLT utilization including persistence and adherence were assessed. Logistic regression was used to assess the association between Lp(a) levels and low-density lipoprotein cholesterol (LDL-C) levels after index LLT, adjusting for baseline characteristics. RESULTS: Overall, 2154 SP and 7179 PP patients met eligibility criteria. Of patients with available laboratory data, only 0.7% (SP) and 0.6% (PP) had Lp(a) test results. In the SP cohort, Lp(a) levels ≥125 nmol/L and ≥175 nmol/L were 26.4% and 17.6%, respectively, and the mean (SD) Lp(a) levels (overall SP cohort 90.4 [97.9] nmol/L) were highest in Black patients (123.4 [117.4]; p<0.001). Statin monotherapy was the most frequently prescribed LLT in SP patients overall (89.4%). Median (interquartile range [IQR]) persistence of LLTs was 227 (91, 649) days and 33.6% achieved ≥80% proportion of days covered (PDC). Patients with Lp(a) ≥175 nmol/L had 2.1 times greater odds of having elevated LDL-C (≥70 mg/dL) post-LLT than those with Lp(a) <175 nmol/L (p = 0.031). Similar findings were observed in the PP population. CONCLUSIONS: Lp(a) screening was rare. Elevated Lp(a) was observed in more than one-quarter of patients receiving LLTs, with the highest mean Lp(a) levels observed in Black patients. Low adherence to LLTs was prevalent and at least half of patients failed to achieve their respective LDL-C target thresholds despite treatment. Finally, high Lp(a) levels were associated with worse LDL-C control. Elsevier 2023-02-23 /pmc/articles/PMC10015179/ /pubmed/36936405 http://dx.doi.org/10.1016/j.ajpc.2023.100476 Text en © 2023 The Authors. Published by Elsevier B.V. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).
spellingShingle Original Research Contribution
Hu, Xingdi
Cristino, Joaquim
Gautam, Raju
Mehta, Rina
Amari, Diana
Heo, Ji Haeng
Wang, Siwei
Wong, Nathan D.
Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study
title Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study
title_full Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study
title_fullStr Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study
title_full_unstemmed Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study
title_short Characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): A real-world US study
title_sort characteristics and lipid lowering treatment patterns in patients tested for lipoprotein(a): a real-world us study
topic Original Research Contribution
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10015179/
https://www.ncbi.nlm.nih.gov/pubmed/36936405
http://dx.doi.org/10.1016/j.ajpc.2023.100476
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