Estimating the Prevalence and Characteristics of Patients Potentially Eligible for Lipoprotein(a)-Lowering Therapies in a Real-World Setting

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

Background

Multiple guidelines recommend detection of and early risk factor management for elevated lipoprotein(a) [Lp(a)]. Effective implementation requires assessment of knowledge and practices regarding elevated Lp(a) among medical specialists.

Aim

To assess awareness, knowledge and practices of the detection and treatment of elevated Lp(a) among specialist physicians in Singapore.

Methods

Seventy-five practicing specialists in cardiology (n = 33) or endocrinology (n = 42) anonymously completed a structured questionnaire that assessed the above three aims.

Results

The majority of respondents (83%) rated their familiarity with Lp(a) as at least average, with a greater percentage of endocrinologists being less familiar with Lp(a) than cardiologists (29% vs. 3%, P < 0.01). 57% were aware of at least one guideline or consensus statement on Lp(a), which was more frequent among cardiologists than endocrinologists (70% vs. 48%, P = 0.05). There were major gaps in knowledge of the prevalence, pathophysiological role, clinical significance and management of elevated Lp(a), correct responses being less than 30%; 44% of respondents (33% cardiologists and 52% endocrinologists) never tested for Lp(a), lack of effective treatment being the most common barrier (59%). A higher proportion of specialists that did not test for Lp(a) rated familiarity with Lp(a) as being low compared with specialists that tested for Lp(a) regularly (33% vs. 13%, P = 0.02). Education and training were considered most useful for improving care of patients with elevated Lp(a).

Conclusion

Major gaps in awareness, knowledge and management of elevated Lp(a) were identified among specialists in Singapore. Education and training of specialists are required to overcome initial barriers to testing.

Prevalence of Lp(a) in a real-world Portuguese cohort: implications for cardiovascular risk assessment

BACKGROUND

Cardiovascular disease (CVD) is a major cause of mortality worldwide, necessitating more refined strategies for risk assessment. Recently, lipoprotein(a) [Lp(a)] has gained attention for its distinctive role in atherosclerosis, yet its prevalence and impact for cardiovascular risk assessment are not well-documented in the Portuguese population. This study aimed to characterize Lp(a) levels in a real-world Portuguese cohort, investigating its prevalence and association with CVD risk.

METHODS

Retrospective and cross-sectional study of adults who underwent serum Lp(a) analysis in a Portuguese hospital between August 2018 and June 2022. Demographic and anthropometric data, laboratory values, relevant comorbidities and lipid-lowering medication were collected.

RESULTS

Of 1134 participants, 28.7% had elevated Lp(a) levels (> 125 nmol/L). A higher prevalence was observed in those with atherosclerotic cardiovascular disease (ASCVD) (45.9%) or a family history of premature CVD (41.9%). Additionally, a significant association was found between elevated Lp(a) levels and traditional CVD risk factors, including hypertension, dyslipidemia, and diabetes mellitus. Among those classified as having low-to-moderate CVD risk by (Systematic COronary Risk Evaluation 2) SCORE2, 55.7% exhibited high Lp(a) levels (> 75 nmol/L), suggesting a potential higher risk of CVD disease.

CONCLUSIONS

The prevalence of elevated Lp(a) in Portugal, notably among those with ASCVD or premature CVD history, is concerning. This study underscores the potential of Lp(a) assessment for a more comprehensive approach to cardiovascular risk assessment. This could improve the stratification of CVD risk and identify individuals who could benefit from early intensive management of their risk factors, ultimately reducing the burden of CVD and cardiovascular-related mortality.

Lifestyle and Lipoprotein(a) Levels: Does a Specific Counseling Make Sense?

Lipoprotein(Lp)(a) is a variant of low-density lipoprotein (LDL), bound to apolipoprotein B100, whose levels are associated with a significant increase in the risk of atherosclerosis-related cardiovascular events, but also to aortic stenosis and atrial fibrillation. Since plasma levels of Lp(a) are commonly considered resistant to lifestyle changes, we critically reviewed the available evidence on the effect of weight loss, dietary supplements, and physical activity on this risk factor. In our review, we observed that relevant body weight loss, a relatively high intake of saturated fatty acids, the consumption of red wine, and intense physical exercise seems to be associated with significantly lower plasma Lp(a) levels. On the contrary, foods rich in trans-unsaturated fatty acids are associated with increased Lp(a) levels. With regard to dietary supplements, coenzyme Q10, L-Carnitine, and flaxseed exert a mild but significant lowering effect on plasma Lp(a).