Lp(a) testing and LDL-C levels among australian ASCVD patients in 2022: a cross-sectional study from the advara heartcare network (PREVAIL)

Abstract Background The proportion of Australians with atherosclerotic cardiovascular disease (ASCVD) who meet secondary prevention low-density lipoprotein cholesterol (LDL-C) targets is uncertain, particularly among those undergoing lipoprotein(a) (Lp(a)) testing. This study describes the characteristics and achievement of LDL-C targets in ASCVD patients, both with and without Lp(a) tests. Methods A cross-sectional study was performed utilising secondary data from the Advara HeartCare cardiology network electronic medical records (EMR). Natural language processing (NLP) was used to extract data from clinical letters between 2011 and 2022 for patients attended during 2022. The 2022 baseline report captures clinical characteristics (i.e,. comorbidities, medications, lab values) in those with and without Lp(a) tests. Results In 2022, a total of 55,427 ASCVD patients were identified, predominantly male (65.1%) with a mean age of 71.2 (12.3). 61% had dyslipidaemia, 58.6% had hypertension, and 21.4% had diabetes. 72.7% were on statins, 19.4% on ezetimibe and 5.6% on PCSK9i. LDL-C information was available for 60.2% (33,381) of all ASCVD patients, with a mean LDL-C of 2.0 mmol/dL. 47.6% and 21.4% had LDL-C levels <1.8 mmol/dL and <1.4 mmol/dL respectively. Lp(a) test results were available for 2.6% (n=1,460) of ASCVD patients, with 87.7% having LDL-C information available, and a mean LDL-C of 1.9 mmol/dL. Among this group, 54.5% and 25.1% had LDL-C levels <1.8 mmol/dL and <1.4 mmol/dL respectively. Conclusions The study highlights suboptimal achievement of LDL-C targets among both ASCVD patients and those tested for Lp(a), underscoring the need to improve secondary prevention strategies and Lp(a) measurement in the ASCVD population.