Study Finds Black, Hispanic Patients Less Likely to Undergo Lp(a) Testing

New research from investigators at Columbia University and Mount Sinai offers insight into the into rates of lipoprotein(a) [Lp(a)] testing in real-world settings among a diverse cohort of patients.

Results of the study, which included more than 1.2 million adult patients, suggests just 0.32% of patients underwent Lp(a) testing, with non-Hispanic Black and Hispanic patients 68% and 72% less likely to have an Lp(a) order than non-Hispanic White patients.¹

“Non-Hispanic Black patients had the highest median Lp(a) levels, followed by Hispanic, with non-Hispanic White patients having the lowest levels,” wrote investigators.¹ “Despite this, we saw that non-Hispanic Black and Hispanics patients were less likely to be ordered an Lp(a) test compared to their non-Hispanic White counterparts.”

As a result of advances in understanding of pathophysiology, recognition of Lp(a) as a cardiovascular risk factor has grown in recent years. A reflection of this growing recognition, the National Lipid Association calls for Lp(a) measurement in all adults at least once in their lifetime in their 2024 update on Lp(a) in clinical practice.^1,2

In the current study, a team of investigators from Columbia University Vagelos College of Physicians and Surgeons and Icahn School of Medicine at Mount Sinai led by Gissette Reyes-Soffer, MD, of the Columbia University Vagelos College of Physicians and Surgeons, sought to examine how various clinical and demographic factors, including race/ethnicity, might influence likelihood of Lp(a) ordering. With this in mind, investigators designed a single-center, retrospective study of patients with at least 1 ICD-10 diagnosis of ASCVD or resistant hyperlipidemia between February 2020 and July 2023, which was obtained though the electronic medical record system used at Columbia University Irving Medical Center.¹

For the purpose of analysis, investigators defined resistant hyperlipidemia as an LDL greater than 160 mg/dL while on statin therapy.¹

Overall, 1,265,646 adult patients received care at Columbia University Irving Medical Center during the aforementioned period. Among this cohort, just 0.32% of adults received an order for an Lp(a) assessment. Of the 1.2 million patients identified, 56,833 met the aforementioned inclusion criteria.¹

Upon analysis, results indicated just 4% of those with ASCVD or resistant hyperlipidemia received an Lp(a) order. Investigators pointed out. Among those receiving an Lp(a) order, 17.3% were Hispanic, 8.7% were non-Hispanic Black, 47.5% were non-Hispanic White, and 27% were Asian or other race/ethnicity.¹

Further analysis demonstrated non-Hispanic Black (0.17%; Rate Ratio [RR], 0.32; 95% CI, 0.26 to 0.40; P <.001) and Hispanic (0.28%; RR, 0.28; 95% CI, 0.23 to 0.32; P <.001) patients had reduced rates of Lp(a) orders ratline to their non-Hispanic White counterparts (2.35%; P < .001). Despite the reduced testing rates, investigators pointed out both non-Hispanic Black and Hispanic patients had greater median Lp(a) levels.¹

Analysis of other factors suggested belonging to deprived socioeconomic groups (RR, 0.39; 95% CI, 0.35 to 0.43; P <.001) or on Medicaid (RR, 0.40, 95% CI, 0.34 to 0.46; P <.001) were less likely to have an Lp(a) order, with this effect persisting after stratification by race/ethnicity. Investigators also pointed out presence of certain diagnoses, such as carotid stenosis, family history of ASCVD and familial hypercholesterolemia, as well as 2 or more diagnoses were associated with a greater likelihood of Lp(a) orders.¹

Of note, this study was published as a preprint at the time of writing and had not yet undergone peer review. Investigators also called attention to multiple limitations with their study, including those inherent with using electronic medical record data, being limited to a 3.5-year period, and inability to draw conclusions on why a test was or was not order for each individual.¹

References:

1. Pavlyha M, Li Y, Crook S, Anderson BR, Reyes-Soffer G. Race/ethnicity and socioeconomic status affect the assessment of lipoprotein(a) levels in clinical practice. Preprint. medRxiv. 2024;2024.05.14.24307362. Published 2024 May 14. doi:10.1101/2024.05.14.24307362
2. Koschinsky ML, Bajaj A, Boffa MB, et al. A focused update to the 2019 NLA scientific statement on use of lipoprotein(a) in clinical practice. J Clin Lipidol. Published online March 29, 2024. doi:10.1016/j.jacl.2024.03.001