Temporal trends in lipoprotein(a) testing among United States veterans from 2014 to 2023

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American journal of preventive cardiology Pub Date : 2024-09-23 DOI:10.1016/j.ajpc.2024.100872
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Abstract

Objective

Lipoprotein (a) [Lp(a)] is a causal, genetically-inherited risk amplifier for atherosclerotic cardiovascular disease (ASCVD). Practice guidelines increasingly recommend broad Lp(a) screening among various populations to optimize preventive care. Corresponding changes in testing rates and population-level detection of elevated Lp(a) in recent years has not been well described.

Methods

Using Veterans Affairs electronic health record data, we performed a retrospective cohort study evaluating temporal trends in Lp(a) testing and detection of elevated Lp(a) levels (defined as greater than 50 mg/dL) from January 1, 2014 to December 31, 2023 among United States Veterans without prior Lp(a) testing. Testing rates were stratified based on demographic and clinical factors to investigate possible drivers for and disparities in testing: age, sex, race and ethnicity, history of ASCVD, and neighborhood social vulnerability.

Results

Lp(a) testing increased nationally from 1 test per 10,000 eligible Veterans (558 tests) in 2014 to 9 tests per 10,000 (4,440 tests) in 2023, while the proportion of elevated Lp(a) levels remained stable. Factors associated with higher likelihood of Lp(a) testing over time were a history of ASCVD, Asian race, and residing in neighborhoods with less social vulnerability.

Conclusion

Despite a 9-fold increase in Lp(a) testing among US Veterans over the last decade, the overall testing rate remains extremely low. The steady proportion of Veterans with elevated Lp(a) over time supports the clinical utility of testing expansion. Efforts to increase testing, especially among Veterans living in neighborhoods with high social vulnerability, will be important to reduce emerging disparities as novel therapeutics to target Lp(a) become available.
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2014 年至 2023 年美国退伍军人脂蛋白(a)检测的时间趋势
目的脂蛋白(a)[Lp(a)]是动脉粥样硬化性心血管疾病(ASCVD)的一个因果遗传风险放大器。实践指南越来越多地建议对不同人群进行广泛的脂蛋白(a)筛查,以优化预防保健。方法利用退伍军人事务部的电子健康记录数据,我们进行了一项回顾性队列研究,评估了从 2014 年 1 月 1 日到 2023 年 12 月 31 日期间未进行过脂蛋白(a)检测的美国退伍军人的脂蛋白(a)检测和脂蛋白(a)水平升高(定义为大于 50 mg/dL)检测的时间趋势。根据人口统计学和临床因素对检测率进行了分层,以调查检测中可能存在的驱动因素和差异:年龄、性别、种族和民族、ASCVD 病史和邻里社会脆弱性。结果在全国范围内,Lp(a) 检测率从 2014 年的每 10,000 名符合条件的退伍军人中检测 1 次(558 次)增加到 2023 年的每 10,000 人中检测 9 次(4,440 次),而 Lp(a) 水平升高的比例保持稳定。随着时间的推移,更有可能接受脂蛋白(a)检测的因素包括:有 ASCVD 病史、亚洲人种以及居住在社会脆弱性较低的社区。随着时间的推移,Lp(a) 升高的退伍军人比例稳定,这支持了扩大检测范围的临床实用性。随着针对脂蛋白(a)的新型疗法的出现,努力增加检测,尤其是在生活在社会脆弱性高的社区的退伍军人中增加检测,对于减少新出现的差异非常重要。
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来源期刊
American journal of preventive cardiology
American journal of preventive cardiology Cardiology and Cardiovascular Medicine
CiteScore
6.60
自引率
0.00%
发文量
0
审稿时长
76 days
期刊最新文献
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