Atherosclerotic cardiovascular disease and measurement of lipoprotein(a) levels in Italy

Background: Lipoprotein(a) [Lp(a)] is a relatively new but underutilized biomarker in the context of atherosclerotic cardiovascular disease (ASCVD). Objectives: To explore the clinical implementation of Lp(a) measurement and current practices in hospital and specialised settings in Italy. Methods: An anonymous online questionnaire was distributed to Italian physicians to examine the habits of Italian clinicians regarding Lp(a) measurement. The survey covered three topics: 1) information on the clinical setting of the physicians, 2) questions for physicians who reported not measuring Lp(a), to understand the reasons for not requesting the test, and 3) questions for physicians who measure Lp(a), to investigate its use in patient management. Results: A total of 978 responses were received. Overall, 63.1% of physicians reported working in a hospital; 12.2% reported being a territorial specialist. Regular Lp(a) measurement was reported by 32.1% of clinicians. Among those who do not measure Lp(a), the main barriers to implementation include high cost and limited availability of the test. The threshold value for defining elevated Lp(a) levels varies significantly among professionals, with 36.7% considering levels above 30 mg/dL to be elevated and 32.7% considering levels above 50 mg/dL to be elevated. Clinical management of patients with elevated Lp(a) primarily includes intensification of lipid-lowering therapy (69.2%), management of cardiovascular risk factors (48.7%), and lifestyle recommendations (37.4%). Conclusions: The survey highlights the heterogeneity in the approach to managing elevated Lp(a) levels among Italian clinicians, underscoring the importance of clear guidelines and greater accessibility to the test to optimize cardiovascular risk stratification and improve clinical outcomes.