Raising Awareness of Lp(a) to Improve Heart Disease Treatment Approaches

Lipoprotein(a) (Lp[a]) levels can lead to plaque build-up in the arteries and, as such, be a notable risk marker for a myriad of cardiovascular issues. Ahead of Lp(a) Awareness on March 24, Nathan Wong, PhD, FACC, FAHA, FNLA, director, University of California (UC) Irvine Heart Disease Prevention Program, professor, Department of Internal Medicine, UC Irvine School of Medicine, joined The American Journal of Managed Care^® to discuss the importance of Lp(a) awareness, as well as the impact of implementing Lp(a)-related electronic health alerts into electronic health records (EHR).

This transcript has been lightly edited for clarity; captions were auto-generated.

Transcript

Can you give a basic overview of Lp(a) and why awareness is so important?

Lp(a) is a lipid particle, like an LDL [low-density lipoprotein] particle that has received an incredible amount of attention lately. It is primarily genetically determined, and it is elevated in about 1 in 5 adults, which makes it imperative that we increase attention about its significance. Numerous epidemiologic Mendelian randomization and genome-wide association studies have shown it to be linked to atherosclerotic cardiovascular disease [ASCVD] events, as well as aortic stenosis, [and] even other cardiovascular conditions such as heart failure and atrial fibrillation. It's very important that the public, as well as the medical community, be aware of its significance as a risk driver for these conditions.

What were the key steps involved in integrating Lp(a) alerts into the EHR at UC Irvine? What was done to encourage adoption among clinicians?

We developed a best practice advisory for the measurement of Lp(a) in the latter part of 2023, where physicians are sent messages for patients of theirs who have been diagnosed with ASCVD or familial hypercholesterolemia, aortic stenosis, or have an LDL of 190 [mg/dL] or higher, or have a family history of ASCVD.

When a physician sees a patient fit in 1 or more of these criteria, there is an alert that appears recommending that they measure Lp(a), and there is a hover where they can go to a link to the American Heart Association statement from 2022 that explains a little bit about Lp(a), and we also make a note for them that if it's 50 milligrams per deciliter or higher, or 125 nanomoles per liter or higher, that more intensive risk factor management is recommended.

Now, in order to get this alert going, this involves a process: you have to know your electronic health record committee. In our case, we use Epic, so we had to know the Epic committee. And it also is very helpful to have a physician champion who had an interest and was supportive of developing such an alert, who was on the committee.

Once it goes through the committee, as well as to another governance committee, then the resources have to be identified. There has to be a programmer who will write the code to create the alert. All this has to be prioritized with the institution’s other needs at the time, and not every institution may necessarily have the resources to create these alerts. It's not a one-size-fits-all approach, certainly, but it requires knowing the people as well as the processes that are involved to get these approved.

Have you seen any measurable changes in patient outcomes or clinical decision-making since implementing the alerts?

With this particular Lp(a), we're actually currently in the process of the design and evaluation of that. We don't have data per se on this alert, but I can speak to a prior alert that we implemented several years earlier, which was a BPA [best practice alert] as well, that alerted physicians who had patients with an LDL cholesterol of 190 [mg/dL] or higher. And from the evaluation of this alert, we have seen that it has been effective in improving statin initiation as well as nonstatin initiation rates. In fact, new statin use seems to have gone up about 50%. We also see dramatic reductions in LDL cholesterol of around 80 points. We also see an increase in the diagnosis of familial hypercholesterolemia.