Abstract 4147267: Utilization, Risk Stratification, and Management of Lipoprotein(a) Results in a Large Academic Medical Center

Introduction: Evidence has grown around the relationship between lipoprotein(a) [Lp(a)] and cardiovascular disease risk. The 2024 focused update on Lp(a) from the National Lipid Association recognizes elevated plasma Lp(a) as an important independent, causal risk factor for atherosclerotic cardiovascular disease and aortic valve stenosis, as well as delineates risk classifications. It is now recommended for patients to have Lp(a) measured at least once in their adult life, with Lp(a) levels <75 nmol/L (30 mg/dL) classified as low risk, individuals with Lp(a) levels ≥125 nmol/L (50 mg/dL) as high risk, and individuals with Lp(a) levels between 75 and 125 nmol/L (30–50 mg/dL) as intermediate risk. Aims: With Lp(a) lab testing recommendations changing and leading to a steady increase in patients who have had Lp(a) drawn, we aimed to understand these patients’ relative risk of cardiovascular comorbidities and events, in addition to current management. Methods: Within a university-based health system, a large data extraction model was used to identify all patients who had undergone Lp(a) testing. In a system of roughly 4,553,100 patients, 1,976 unique patients have had Lp(a) drawn since 2013. This population was then subclassified by risk groups, as outlined above. Results: Testing thus far, using new recommendations for classifications of patients, places 1491 patients in the low-risk category, 241 in the intermediate-risk category, and 211 in the high-risk category, summarized in Table 1. In this population, patients in the high risk Lp(a) group, tended to have higher rates of CAD, PAD, ACS and CVA events. Notably, no significant differences exist regarding more aggressive management of these patients with either escalation of lipid lowering therapy including high-intensity statins, ezetimibe and PCSK9-i or with subspecialist referrals. There are, however, 7 patients undergoing apheresis from the high-risk group. Conclusions: Consistent with current literature, patients stratified to the higher risk lp(a) group had higher rates of cardiovascular comorbid conditions and events, though do not seem to be managed more aggressively than those in lower risk groups. Opportunity exists in escalating therapy and referring to subspecialists for consideration of therapies like PCSK9-inhibitors, lipoprotein apheresis, and soon, direct Lp(a) lowering medications.