Abstract TP041: To Check or Not To Check? - Lipoprotein (a) and Covert White Matter Disease

Background: Elevated Lipoprotein (a) [Lp(a)] levels have been associated with cerebrovascular and cardiovascular risk and multiple professional organizations have recommended measuring Lp(a) at least once in adults for risk stratification. In clinical practice, however, Lp(a) is rarely checked in patients with acute ischemic stroke. We aimed to investigate (1) real-world Lp(a) measurement within a large academic health system, and (2) the association between Lp(a) and white matter disease in a cohort of acute ischemic stroke (AIS) patients where Lp(a) measurement is routine. Methods: We used the Mount Sinai Health System (MSHS) Get with the Guidelines database to identify patients admitted with AIS in 2024 in whom Lp(a) was measured. The MSHS consists of one comprehensive, one thrombectomy-capable, and four primary stroke centers. Of these six hospitals, one primary stroke center was the only hospital participating in the Lp(a) study. We calculated the proportion of total AIS admissions in whom Lp(a) was measured for the other five hospitals (i.e., routine clinical care cohort). Among AIS patients participating in the Lp(a) study at this primary stroke center, we abstracted demographic information, clinical characteristics, and Fazekas score, which is a validated marker of white matter disease. We assessed the association between Lp(a) and Fazekas score, stratified by black vs. white race. Results: In the routine clinical care cohort, Lp(a) was measured in 8.3% of patients overall and ranged from 4.1% to 11.8% by hospital (Table 1). In the Lp(a) cohort, Lp(a) was measured for 70.2% (n=126) of patients. Baseline characteristics of the Lp(a) cohort are shown in Table 2. Among patients with Fazekas score 1, mean Lp(a) was 127.6 mg/dL for Black/African American and 67.1 mg/dL for White patients. For Fazekas score 2, mean Lp(a) was 135.5 mg/dL and 68.4 mg/dL, respectively. For Fazekas score 3, mean Lp(a) was 148.4 mg/dL and 179.1 mg/dL, respectively. Discussion: Lp(a) is infrequently checked in routine clinical care of stroke patients despite growing awareness of its association with cerebrovascular and cardiovascular disease. The association of Lp(a) and covert cerebrovascular disease, as measured by the Fazekas score, provides more evidence for routinely assessing Lp(a) in stroke patients as part of risk factor modification regardless of suspected stroke mechanism.