全国队列中脂蛋白(a)检测的预测因素:退伍军人健康管理局的见解

IF 4.3 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS American journal of preventive cardiology Pub Date : 2024-09-01 DOI:10.1016/j.ajpc.2024.100767
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引用次数: 0

摘要

治疗领域心血管疾病/心血管疾病风险因素背景脂蛋白(a)[Lp(a)]是一种由基因决定的、独立的、导致动脉粥样硬化性心血管疾病(ASCVD)的风险因素。多种实践指南越来越多地建议通过脂蛋白(a)检测来完善心血管风险评估。我们利用退伍军人事务部(VA)电子健康记录、医疗保险索赔和社区护理中的数据建立了一个回顾性队列,这些退伍军人在 2020 年 7 月 1 日至 2023 年 6 月 30 日期间至少在退伍军人事务部门诊就诊过一次,并且在最后一次退伍军人事务部门诊就诊日期前 180 天内至少开过一次处方,以确保与医疗系统有充分的联系。我们评估了患者层面的 Lp(a) 检测社会人口学和临床预测因素。预测因素包括自我报告的种族和民族、社会脆弱性、ASCVD 的存在和类型以及低密度脂蛋白胆固醇(LDL-C)水平。邻里社会脆弱性采用美国疾病预防控制中心的社会脆弱性指数(SVI)进行定义,并按四分位数进行分类(数字越大,脆弱性越高)。结果在 5,331,271 名退伍军人中,中位年龄为 67 岁(IQR 52-76),女性占 10.3%;69.6% 为白人,18.8% 为黑人,7.4% 为西班牙裔。符合条件的退伍军人中接受过脂蛋白(a)检测的不到 1%。年龄较大、白种人、非西班牙裔、居住在城市社区和 SVI 较低的退伍军人(弱势社区较少)更有可能接受脂蛋白(a)检测。经过多变量调整后,女性、被认定为黑人或亚裔的退伍军人以及已确诊为 ASCVD 的退伍军人更有可能接受脂蛋白(a)检测(图)。在 130 个退伍军人机构中,脂蛋白(a)检测率为 0.01-3.40%。在退伍军人医疗机构接受检测的人员中,脂蛋白(a)水平的中位数为 16 mg/dL(IQR 6-53),其中 26% 患有 ASCVD 的退伍军人和 20% 未患 ASCVD 的退伍军人的脂蛋白(a)水平为 50 mg。约四分之一的受检者脂蛋白(a)水平升高。随着靶向治疗药物的上市,制定策略以改善脂蛋白(a)的整体检测并减少社会人口因素导致的现有检测差距至关重要。
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PREDICTORS OF LIPOPROTEIN(A) TESTING ACROSS A NATIONAL COHORT: INSIGHTS FROM THE VETERANS HEALTH ADMINISTRATION

Therapeutic Area

ASCVD/CVD Risk Factors

Background

Lipoprotein(a) [Lp(a)] is a genetically determined, independent, causal risk factor for atherosclerotic cardiovascular diseases (ASCVD). Multiple practice guidelines increasingly recommend Lp(a) testing to refine cardiovascular risk assessment. We aimed to evaluate sociodemographic and clinical factors influencing Lp(a) testing in the Veterans Affairs (VA) healthcare system.

Methods

We assembled a retrospective cohort using data from the VA electronic health record, Medicare claims, and community care for Veterans having at least one outpatient visit in the VA between July 1, 2020, and June 30, 2023, and at least one prescription filled in 180 days before the date of the last VA outpatient encounter to ensure adequate healthcare system contact. We evaluated patient-level sociodemographic and clinical predictors of Lp(a) testing. Predictors included self-reported race and ethnicity, social vulnerability, the presence and type of ASCVD, and low-density lipoprotein cholesterol (LDL-C) levels. Neighborhood social vulnerability was defined using the CDC's Social Vulnerability Index (SVI) and categorized by quartiles (higher numbers associated with higher vulnerability). Associations between patient characteristics and Lp(a) testing were estimated using generalized estimating equations.

Results

Among 5,331,271 Veterans, the median age was 67 years (IQR 52-76) with 10.3% female; 69.6% identified as White, 18.8% Black, 7.4% Hispanic. Less than 1% of eligible Veterans have received Lp(a) testing. Lp(a) was more likely to be tested among Veterans with older age, White race, non-Hispanic ethnicity, living in urban neighborhoods, and those with low SVI (less vulnerable neighborhoods). After multivariable adjustment, Lp(a) testing was more likely among women, Veterans identified as Black or Asian, and those with established ASCVD (Figure). Across 130 VA facilities, Lp(a) testing ranged from 0.01-3.40%. The median Lp(a) level among those tested at VA facilities was 16 mg/dL (IQR 6-53) with 26% of Veterans with ASCVD and 20% of Veterans without ASCVD having Lp(a) levels >50 mg.

Conclusions

Lp(a) testing is infrequent in the VA healthcare system, with disparities in testing by sociodemographic and clinical characteristics. About a quarter of those tested had elevated Lp(a) levels. Developing strategies to improve overall Lp(a) testing and reduce existing gaps in testing by sociodemographic factors is critical as targeted therapeutics become available.
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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%
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0
审稿时长
76 days
期刊最新文献
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