Experts urge screening to significantly cut the number of cardiovascular events and early deaths.
Routine lipoprotein(a) testing could prevent 60 heart attacks, 13 strokes and 26 early deaths per 10,000 people, according to a new study published in Athersclerosis.
Researchers found that Lp(a) testing would have reclassified 20% of participants as high-risk for cardiovascular disease, which would have prompted earlier intervention and additional medications.
Researchers randomly selected 10,000 people from the UK Biobank aged 40–69 years for whom lipid testing information was available.
They constructed a microsimulation model of participants, looking at incident and recurrent myocardial infarction (MI) and stroke (ischemic and haemorrhagic) up until they each would have turned 85.
Screening in this model was estimated to lead to 169 years of life gained and 217 years of living in good health when compared to Australian standard of care.
Dr Jed Morton, research fellow in the Centre for Medicine Use and Safety at Monash University, told media that Lp(a) testing in Australia should be routine, and from a young age if it’s known to run in the family.
“There is solid evidence to show that Lp(a) can be a major risk factor for cardiovascular disease – the earlier people are tested, the better the chances are of intercepting the problem before it escalates,” he said.
“Now is the time to act.”
Researchers explained that the overwhelming majority of individuals with high Lp(a) were unaware of their increased risk and would therefore not have initiated preventative measures.
Researchers noted that there were some highly effective Lp(a) treatments in late-stage development but that effort could still be made in the meantime to lower overall cardiovascular risk without directly lowering Lp(a).
Lp(a) testing would prompt reclassification of individuals’ risk and more intensive management of their other cardiovascular risk factors that might otherwise go untreated, they said.
Dr Morton told The Medical Republic that while Lp(a) is a useful predictor of CVD, testing isn’t covered under Medicare.
“It is a once in a lifetime test and costs about as much as a standard lipid panel,” he said.
“Remove the private pathology surcharge and the test likely becomes so much cheaper that we could perform universal screening.”
Lp(a) testing offers significant value for improving health outcomes and optimising resource allocation if implemented, researchers said. The benefits from preventing cardiovascular events by testing in those aged 40-69 are substantial given the high risk of CVD among the population with high Lp(a).
“Implementation of Lp(a) testing is not only highly warranted from a clinical perspective but is likely to come with a financial return on investment when considered from the societal perspective,” authors said.
The model suggested that screening would have saved about $3.3 million AUD in healthcare costs in 2023.
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However, screening increased medication cost by $5.7 million and increased testing costs of about $230,000. Combined with the indirect cost savings from a societal perspective (such as productivity) resulted in a total cost saving of roughly $85 per person.
The risk of MI and stroke of the model population was based on age, sex, LDL-C concentration, systolic blood pressure, Lp(a) concentration, diabetes and smoking status.
A fifth of study participants had an Lp(a) of 105 nmol/L (50 mg/dL) or higher. The median LDL-C was 3.7 mmol/L and median systolic BP was 138 mmHg.
The UK Biobank included more than 500,000 individuals enrolled between 2006 and 2010, with follow-up data available up to 2021.
The study noted that a “healthy volunteer” bias existed within the cohort, but that this only further strengthened the findings as the CVD and mortality rates in the model were likely underestimates.
Instituting routine screening would require systemic change, Dr Morton told TMR, not just to clinical guidelines.
“I think the system is relatively unresponsive to best practice, and favours only changes that can find the resources to go through an MSAC or PBAC submission,” he said.
A recent paper published in the European Heart Journal also highlighted the role of Lp(a) screening in predicting major adverse cardiovascular events (MACE).
Swedish researchers studied over 61,000 first-degree relatives (FDR) of more than 41,000 individuals who’d had their Lp(a) levels measured.
Over a median follow-up of 19 years, they found that by age 65, about 6% of FDR of those with low Lp(a) had experienced MACE, compared with 8% of FDR of those with very high Lp(a) levels.
Overall, elevated Lp(a) was linked to a 30% higher risk of MACE in FDR. Researchers suggested the findings made a case for cascade screening.
