Prevention & lipidsCohort study
Lipoprotein (a) Testing and Changes in Lipid-Lowering Therapy in Patients With ASCVD: Findings From the cvMOBIUS-2 Registry
- Electronic health record patient data from 13 US health systems
- registry
- multivariable logistic regression
Authors' conclusion
Lp(a) testing remains low despite guideline recommendations. Although those with elevated Lp(a) were more likely to undergo lipid-lowering therapy intensification, over half of those with Lp(a)≥200 nmol/L or ≥ 80 mg/dL had no change in therapy. These results highlight a significant gap in clinical care and an opportunity to improve the use of Lp(a) testing to guide LDL-C management.
Study context
- Population
- Patients with atherosclerotic cardiovascular disease in 13 US health systems, January 1, 2021 to January 1, 2025patients with atherosclerotic cardiovascular disease, 36,410 (1.9%) had an Lp(a) test
- Participants
- 1,948,540 patients
- Exposure
- Factors associated with Lp(a) testing and high Lp(a) (≥125 nmol/L or ≥50 mg/dL); changes in lipid-lowering therapy after Lp(a) testing stratified by Lp(a) level
Main finding
As reported in the abstract
Patients who had an Lp(a) test
36 410 (1.9%)
Testing in 2021
0.2%
Testing in 2024
0.8%
Observational data: associations, not effects.
Further findings
Odds of undergoing Lp(a) testing
| Comparison | odds ratio (95% CI) | |
|---|---|---|
| female sex · less likely to undergo testing · multivariable logistic regression | 0.95 (0.93–0.98) | |
| non-Hispanic Black patients · less likely to undergo testing · multivariable logistic regression | 0.79 (0.76–0.82) | |
| 0.512Odds ratio (log scale) |
Odds of elevated Lp(a)
| Comparison | odds ratio (95% CI) | |
|---|---|---|
| female sex · higher odds of elevated Lp(a) · multivariable logistic regression | 1.19 (1.14–1.25) | |
| non-Hispanic Black patients · higher odds of elevated Lp(a) · multivariable logistic regression | 2.83 (2.63–3.05) | |
| 0.20.5125Odds ratio (log scale) |
| Outcome | Values | Estimate |
|---|---|---|
| Intensification of lipid-lowering therapy in those with LDL-C≥55 mg/dL, by Lp(a) level | Lp(a) 125 to <200 nmol or 50 to <80 mg/dL 32.7% · Lp(a)≥200 nmol or ≥80 mg/dL 38.2% |
- Intensification of lipid-lowering therapy in those with LDL-C≥55 mg/dL, by Lp(a) level: P trend <0.001
Elevated Lp(a) among tested patients
- Tested patients with elevated Lp(a)
- 31.1%
Original publication
Summarised from the published abstract; every number is checked against it