Only 21.7% of younger STEMI patients had Lp(a) measured within 1 year; 32.5% had levels ≥100 nmol/L; older age and CAD risk factors predicted lack of measurement.
In a contemporary Canadian registry, only 1 in 5 young STEMI patients had Lp(a) measured within 1 year of their event, highlighting a significant gap in the real-world implementation of secondary prevention guidelines.
Abstract Background Current guidelines recommend baseline Lipoprotein(a) (Lp(a)) measurement as part of risk stratification for future cardiovascular disease. However, the real-world implementation of these recommendations for the secondary prevention of atherosclerotic cardiovascular disease remains unclear. Purpose This study is the first to assess the practical use of Lp(a) measurement in the care of young ST-elevation myocardial infarction (STEMI) patients within a Canadian healthcare system. Methods We conducted a retrospective analysis of STEMI patients 65 years old presenting to 13 regional hospitals between January 2016 and December 2022. The primary objective was to determine the proportion of patients who had baseline Lp(a) levels measured prior or within 1 year following their index STEMI hospitalization. The secondary objective was to identify predictors of Lp(a) measurement at any point in their lifetime in this population. Results Among 1,262 patients meeting the inclusion criteria, 1,106 (mean age 55.9±7 years, 88.1% male) were included in the final analysis. Two hundred and forty (21.7%) had an Lp(a) measurement prior or within 1 year of STEMI. Of these, 78(32.5%) had Lp(a) levels ≥100 nmol/L, while 162(67.5%) had levels 100 nmol/L. Based on univariable analysis, patients were less likely to have Lp(a) measured at any point in their lifetime if they were older (OR 0.71(95% CI:0.65, 0.78), p0.001), had peripheral artery disease (OR 0.25(0.06, 1.09), p=0.064), had traditional coronary artery disease (CAD) risk factors (hypertension: OR 0.66(0.51,0.85), p=0.001; smoking: OR 0.64(0.48,0.85), p=0.003; stroke/TIA: OR 0.46(0.22,0.96), p=0.04) or a lower baseline LDL-C levels (OR 0.87(0.77, 0.98), p=0.027). Older age (OR 0.68(0.60, 0.75), p0.001), smoking (0R 0.68(0.49,0.96), p=0.027), and higher BMI (OR 0.81(0.68,0.95), p=0.011) remained significantly associated with a lack of Lp(a) measurement after multivariate analysis. Among those with Lp(a) testing, approximately two-thirds had it measured before or within six months of hospitalization, while one-third had their first measurement more than 12 months post-discharge. Conclusions In the contemporary era, only 1 in 5 younger STEMI patients had LP(a) measurement within 1 year of their index event. Moreover, many patients had no Lp(a) measurement during their lifetime; this was associated with certain clinical factors such as increasing age and the presence of CAD risk factors. With the development of novel targeted therapeutics, additional studies to understand why Lp(a) is not being measured, and strategies to increase timely Lp(a) assessment in this high-risk population are warranted.
Atefi et al. (2025) studied this question. Only 21.7% of younger STEMI patients had Lp(a) measured within 1 year; 32.5% had levels ≥100 nmol/L; older age and CAD risk factors predicted lack of measurement.
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