Increasing Provider Awareness of Lp(a) Testing for Patients at Risk for Cardiovascular Disease: A Comparative Study

Overview

Journal Am J Prev Cardiol

Specialty Cardiology & Vascular Diseases

Date 2024 Dec 25

PMID 39720768

Authors

Wael E Eid

Emma Hatfield Sapp

Callen Conroy

Coby Bessinger

Cassidy L Moody

Ryan Yadav

Reece Tolliver

Joseph Nolan

Suzanne M Francis

Affiliations

Soon will be listed here.

Abstract

Background: Lipoprotein(a) [Lp(a)] is a low-density lipoprotein variant with atherogenic, thrombogenic, and pro-inflammatory properties that may have numerous pathologic effects, including dyslipidemia. Screening for Lp(a) is clinically significant, due to its causal role in atherosclerotic cardiovascular disease (ASCVD). Among clinicians, however, there remains a general lack of both clinical awareness of Lp(a) and adequate tools to track Lp(a) testing in patients.

Objective: To study factors affecting Lp(a) screening by: i) determining the effectiveness of messaging providers at a large community health system about Lp(a) screening and measuring the subsequent percentage of Lp(a) tests requested; and ii) by determining the percentage of patients who obtained Lp(a) testing after being advised by the provider.

Methods: From December 2022 through March 2023, messages detailing the need for Lp(a) screening were sent via the Epic EHR™ to providers of patients meeting criteria for Lp(a) testing in advance of scheduled patient appointments. In this prospective study, providers were randomized into 2 groups: those receiving the pre-appointment message (Group 1) and those not receiving the pre-appointment message (Group 2).

Results: Sending pre-appointment messages correlated with more Lp(a) orders (16.6 % v. 4.7 %, < 0.001) and consequently with more tests performed (10.2 % v. 3.7 %, < 0.001). Among provider types, nurse practitioners and physician assistants had the highest number of Lp(a) results per order ( = 16.40, < 0.001), achieving 30.8-39.1 % more test results, even if they did not receive the pre-appointment message. Distribution of Lp(a) values in patients was 59.7 % ≤ 29 mg/dL; 9.7 % > 29 and < 50mg/dL; and 30.6 % ≥ 50 mg/dL.

Conclusion: Providers who received pre-appointment messages via an EHR were associated with requesting more tests and consequently receiving more Lp(a) results, compared with providers who did not receive messages.

Citing Articles

Deficient perceptions and practices concerning elevated lipoprotein(a) among specialists in Singapore.

Loh W, Pang J, Simon O, Chan D, Watts G Front Cardiovasc Med. 2025; 12:1527351.

PMID: 40027516 PMC: 11868285. DOI: 10.3389/fcvm.2025.1527351.

References

Kronenberg F . Lipoprotein(a): from Causality to Treatment. Curr Atheroscler Rep. 2024; 26(3):75-82. PMC: 10881767. DOI: 10.1007/s11883-024-01187-6. View

Varvel S, McConnell J, Tsimikas S . Prevalence of Elevated Lp(a) Mass Levels and Patient Thresholds in 532 359 Patients in the United States. Arterioscler Thromb Vasc Biol. 2016; 36(11):2239-2245. DOI: 10.1161/ATVBAHA.116.308011. View

Eidensohn Y, Bhatla A, Ding J, Blumenthal R, Martin S, Marvel F . Testing practices and clinical management of lipoprotein(a) levels: A 5-year retrospective analysis from the Johns Hopkins Hospital. Am J Prev Cardiol. 2024; 19:100686. PMC: 11278112. DOI: 10.1016/j.ajpc.2024.100686. View

Eid W, Sapp E, Wendt A, Lumpp A, Miller C . Improving Familial Hypercholesterolemia Diagnosis Using an EMR-based Hybrid Diagnostic Model. J Clin Endocrinol Metab. 2021; 107(4):1078-1090. PMC: 8947798. DOI: 10.1210/clinem/dgab873. View

Li Q, Campan A, Ren A, Eid W . Automating and improving cardiovascular disease prediction using Machine learning and EMR data features from a regional healthcare system. Int J Med Inform. 2022; 163:104786. DOI: 10.1016/j.ijmedinf.2022.104786. View

Schmidt K, Noureen A, Kronenberg F, Utermann G . Structure, function, and genetics of lipoprotein (a). J Lipid Res. 2016; 57(8):1339-59. PMC: 4959873. DOI: 10.1194/jlr.R067314. View

Thomas P, Vedel-Krogh S, Nordestgaard B . Measuring lipoprotein(a) for cardiovascular disease prevention - in whom and when?. Curr Opin Cardiol. 2023; 39(1):39-48. DOI: 10.1097/HCO.0000000000001104. View

Baragetti A, Da Dalt L, Norata G . New insights into the therapeutic options to lower lipoprotein(a). Eur J Clin Invest. 2024; 54(9):e14254. DOI: 10.1111/eci.14254. View

Catapano A, Tokgozoglu L, Banach M, Gazzotti M, Olmastroni E, Casula M . Evaluation of lipoprotein(a) in the prevention and management of atherosclerotic cardiovascular disease: A survey among the Lipid Clinics Network. Atherosclerosis. 2023; 370:5-11. DOI: 10.1016/j.atherosclerosis.2023.02.007. View

10.

Ellis K, de Isla L, Alonso R, Fuentes F, Watts G, Mata P . Value of Measuring Lipoprotein(a) During Cascade Testing for Familial Hypercholesterolemia. J Am Coll Cardiol. 2019; 73(9):1029-1039. DOI: 10.1016/j.jacc.2018.12.037. View

11.

Koschinsky M, Soffer D, Boffa M . What's next for lipoprotein(a)? A National Lipid Association report from an Expert Panel Discussion. J Clin Lipidol. 2024; 18(6):e886-e892. DOI: 10.1016/j.jacl.2024.06.005. View

12.

Nurmohamed N, Kaiser Y, Schuitema P, Ibrahim S, Nierman M, Fischer J . Finding very high lipoprotein(a): the need for routine assessment. Eur J Prev Cardiol. 2021; 29(5):769-776. DOI: 10.1093/eurjpc/zwab167. View

13.

Wilson D, Jacobson T, Jones P, Koschinsky M, McNeal C, Nordestgaard B . Use of Lipoprotein(a) in clinical practice: A biomarker whose time has come. A scientific statement from the National Lipid Association. J Clin Lipidol. 2022; 16(5):e77-e95. DOI: 10.1016/j.jacl.2022.08.007. View

14.

Mukherjee D, Nissen S . Lipoprotein (a) as a Biomarker for Cardiovascular Diseases and Potential New Therapies to Mitigate Risk. Curr Vasc Pharmacol. 2023; 22(3):171-179. DOI: 10.2174/0115701611267835231210054909. View

15.

Qureshi N, Humphries S, Seed M, Rowlands P, Minhas R . Identification and management of familial hypercholesterolaemia: what does it mean to primary care?. Br J Gen Pract. 2009; 59(567):773-6. PMC: 2751920. DOI: 10.3399/bjgp09X472674. View

16.

Cegla J, France M, Marcovina S, Neely R . Lp(a): When and how to measure it. Ann Clin Biochem. 2020; 58(1):16-21. PMC: 7791270. DOI: 10.1177/0004563220968473. View

17.

Tsimikas S, Stroes E . The dedicated "Lp(a) clinic": A concept whose time has arrived?. Atherosclerosis. 2020; 300:1-9. DOI: 10.1016/j.atherosclerosis.2020.03.003. View

18.

Eid W, Sapp E, McCreless T, Nolan J, Flerlage E . Prevalence and Characteristics of Patients With Primary Severe Hypercholesterolemia in a Multidisciplinary Healthcare System. Am J Cardiol. 2020; 132:59-65. DOI: 10.1016/j.amjcard.2020.07.008. View

19.

Jones L, McMinn M, Kann D, Lesko M, Sturm A, Walters N . Evaluation of a multidisciplinary lipid clinic to improve the care of individuals with severe lipid conditions: a RE-AIM framework analysis. Implement Sci Commun. 2021; 2(1):32. PMC: 7977494. DOI: 10.1186/s43058-021-00135-8. View

20.

Vikulova D, Grubisic M, Zhao Y, Lynch K, Humphries K, Pimstone S . Premature Atherosclerotic Cardiovascular Disease: Trends in Incidence, Risk Factors, and Sex-Related Differences, 2000 to 2016. J Am Heart Assoc. 2019; 8(14):e012178. PMC: 6662126. DOI: 10.1161/JAHA.119.012178. View