Physician perspectives on Lp(a) testing and management in patients with cardiovascular disease: interviews from seven countries across five world health organization regions from INTERASPIRE

Abstract

AIMS: Lipoprotein(a) (Lp(a)) is a genetic causal risk factor for atherosclerotic cardiovascular disease (ASCVD), irrespective of ancestry. INTERASPIRE is an international cohort study of secondary prevention conducted in 14 countries from all 6 WHO regions. METHODS AND RESULTS: In a sub-study of seven countries (China, Colombia, Kenya, Nigeria, Malaysia, Poland, UAE), physicians involved in INTERASPIRE were contacted to investigate ASCVD knowledge and elicit perspectives on Lp(a) testing and management. Study physicians underwent telephone interviews conducted by trained research assistants in national languages using specially developed questionnaires. 245 physicians underwent interview: 55% cardiologists, 28% general physicians, 10% endocrinologists and 7% lipid specialists. 43% had access to Lp(a) measurement but, of these, only 50% measured it routinely, with significant variation between countries. Physicians were most likely to request Lp(a) testing in premature coronary disease (91%), after second or recurrent coronary event (81%) and in those with first-degree relatives with high Lp(a) (82%). More than two-thirds of physicians received Lp(a) results expressed in mass units. An elevated Lp(a) was defined variably, most commonly >50 mg/dL by 25%, and 32% were unsure or did not know. 94% believed that Lp(a) testing was beneficial and 81% would advise testing of first-degree relatives. CONCLUSION: Whilst most physicians believe that Lp(a) testing would benefit patients and their relatives, there is marked heterogeneity in access to Lp(a) testing. Interpretation of an elevated Lp(a) varies widely and about one-third of physicians were unsure or did not know. There is a critical need for physician education on Lp(a) to inform decision-making in clinical practice.