Public health recommendations for Lp(a) measurement

Measurement of lipoprotein (a): Benefits, barriers and recommendations.

Key Takeaway

Key Benefits

Identifies high-risk individuals
Improves management of patients with elevated Lp(a)
Clinical and economic benefits to healthcare system and society^*
Helps development of epidemiological data

Key Barriers

Perception that the measure may have limited clinical value
Lack of awareness on Lp(a) and of data on the CV benefit of reducing Lp(a)
Technical barriers, clinical guidelines barriers, and healthcare system barriers

Key Recommendations

Educational campaigns for physicians and patients on Lp(a) and its role in ASCVD
Collaboration of scientific communities and industry to address technical challenges and deficiencies in clinical guidelines
Policy intervention for national ASCVD plans to acknowledge the importance of Lp(a)

Why This Matters

Elevated Lp(a) concentration (>50 mg/dL or ~105 nmol/L), is an inherited risk factor for ASCVD and the most common form of hyperlipidemia
Clinical guidelines recommend Lp(a) measurement as a routine part of clinical assessment in high-risk individuals
Uptake of Lp(a) concentration measurement is limited
Lack of specific pharmaceutical treatment for elevated Lp(a) is perceived as a limitation to effectively prevent ASCVD risk

This study investigated the clinical utility of measuring Lp(a) concentrations for patients, its economic benefit to healthcare systems and society, and barriers that may limit the uptake of measurement of Lp(a) concentration; it also provided policy recommendations that would help addressing those barriers.

Study Design

Two-step analysis was carried out to answer the research questions

Step 1

Structured literature review^† (of publications from 2016 to 2020) was performed to identify:
- Economic and health benefits and costs of measuring Lp(a) concentration
- Potential barriers to the uptake of the measure
- Potential solutions to address them

Step 2

Literature review-findings were discussed with an advisory board attended by European- and United States-based clinical, policy and bioethics experts together with patient organizations from both regions
Anecdotal evidence was collected from three European patients via anonymous interviews

Key Results

A total of 88 publications were considered for the analysis.

Benefits of Measuring LP(a) Concentration

Benefits to Patients	Facilitates identification and better management of patients at high CV risk by allowing more accurate risk stratification Enables physicians to provide appropriate preventive care to patients, treat other treatable risk factors and perform cascade screening Could reduce premature CVD events, associated deaths and generate healthcare system savings Might empower adherence to recommended therapy and adoption of beneficial changes in their lifestyle habits Close relatives of individuals with elevated Lp(a) could be identified and treated earlier (if needed) Could raise awareness about elevated Lp(a) being an inherited cause of premature ASCVD
Benefits to Healthcare System	May be cost-effective and potentially cost saving Wider access to Lp(a) measurement could improve the targeting of lipid lowering treatment and other preventive therapies, leading to: Reduction in hospital admissions Reduction in the need for familial hypercholesterolemia testing Can potentially make healthcare systems more resilient and well-prepared for instances of patient influx In patients with Lp(a) concentrations >175 nmol/L, receiving experimental products in ongoing trials, the annual CVD incidence could potentially be reduced by ≥20% (estimated), possibly translating into healthcare savings
Other Benefits	Identifying eligible patients to maximize the benefits of specific treatments in developmental stage and to avoid the health impact of delayed diagnosis Supporting the collection of up-to-date epidemiological data needed in healthcare planning and decision making Reimbursement of L p(a) concentration measurement and its availability to all adults would lead to fewer discrepancies in the uptake of the test across socioeconomic groups, different parts of the country, and may contribute to reduced inequities in CVD care related to ethnicity

Barriers to the Uptake of LP(a) Measurement

Limited Perception of Value and Lack of Awareness of CVD Risk	Physicians: May have a limited perception of the clinical utility of the Lp(a) test due to unavailability of therapeutic option for high Lp(a) Patients: May lack awareness of family history of ASCVD or of elevated Lp(a) concentrations
Technical and Clinical Guidelines Barriers	Lack of standardized assays on commercial platforms Utilization of different units to measure Lp(a) Lack of statements of measuring Lp(a) in some clinical guidelines Lack of clear and actionable recommendations in clinical guidelines on how physicians should manage a patient with elevated Lp(a)
Healthcare System Barriers	Limited reimbursement of the Lp(a) concentration measure and spending control measures Relatively few laboratories currently providing an Lp(a) assay in some countries - a barrier to sample flow
Other Barriers	Measure of Lp(a) concentration cannot be easily found in some of the paper and electronic forms used by physicians Lack of patients’ awareness on Lp(a) and familial risk

Policy Recommendations to Support a Wider Uptake of LP(a) Measurement

Type of Barrier	Policy Recommendations Value Perception and Lack
Value Perception and Lack of Awareness Barriers	Educational campaigns targeting physicians and patients on Lp(a) and its role in ASCVD Increased dissemination and socialization activities of recent guidelines on measuring Lp(a) concentration
Technical and Clinical Guidelines Barriers	Collaboration of scientific committees and the industry for standardization and validation of Lp(a) assays Updating clinical guidelines to cover Lp(a) and incorporate clear and actionable recommendations for patients with elevated Lp(a)
Healthcare System Barriers	Need of more studies demonstrating the benefits of measuring Lp(a) concentration to increase policymaker’s awareness, focus and prioritization of the issue Provision of sufficient laboratories for Lp(a) measurement with better and cheaper assays more widely available

For additional details, please refer to the source publication, Catapano AL, et al.
^*Before the availability of Lp(a) lowering pharmacological treatments
^†Via google scholar and PubMed

Abbreviations

ASCVD, atherosclerotic cardiovascular disease; CV, cardiovascular; CVD, cardiovascular disease; Lp(a), lipoprotein (a).

Reference

Catapano AL, Daccord M, Damato E, Humphries SE, Neely RDG, Nordestgaard BG, et al. How should public health recommendations address Lp(a) measurement, a causative risk factor for cardiovascular disease (CVD)? Atherosclerosis. 2022;349:136–143. doi: 10.1016/j.atherosclerosis.2022.02.013. PMID: 35292153.

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MAT-KW-2200333/V1/NOV2022