Heart health risk ‘hidden’ without routine testing: Study

Routine testing for a specific lipoprotein could identify a ‘dangerously underdiagnosed’ condition that puts patients at higher risk of cardiovascular disease, researchers suggest.
 
Elevated levels of lipoprotein(a), known as Lp(a), impacts an estimated one in five people worldwide and is an inherited, lifelong, and independent risk factor for heart attacks, strokes, aortic stenosis, and premature cardiovascular events.
 
But it isn’t routinely measured in general practice, nor is it funded under Medicare, and most people with elevated levels don’t know they’re at risk.
 
International research led by Monash University shows routine testing is not only clinically important in terms of saving lives, but also cost-effective to the health system.

Published in Atherosclerosis, the study analysed data from more than 10,000 adults in the United Kingdom. The authors describe the results as ‘striking’.
 
Routine Lp(a) testing would have reclassified 20% of participants as high-risk, leading to earlier intervention with blood pressure or cholesterol-lowering medications.
 
Health economic modelling used in the research shows that testing could prevent 60 heart attacks, 13 strokes and 26 early deaths per 10,000 people.
 
Senior author and health economist at Monash University, Professor Zanfina Ademi, said high Lp(a) is ‘dangerously underdiagnosed’, and testing should become standard practice.
 
‘In Australia, Lp(a) testing is a simple blood test that GPs and other clinicians can order as part of a standard pathology request,’ she told newsGP.
 
‘For most people, it only needs to be done once in a lifetime, as Lp(a) levels are genetically determined and remain stable over time.
 
‘What makes this test important is that around one in five people have elevated Lp(a) concentrations, which substantially increases their lifetime risk of cardiovascular disease … and if it is not measured, this risk remains hidden.’
 
Global testing rates are very low (1–2%) but the study’s authors recommend Lp(a) testing in Australia should be routine, and from a young age if it’s known to run in the family.
 
Professor Ademi said although there are no specific medicines available yet to lower Lp(a) directly, several promising therapies are in late-stage development and will initially be available for secondary prevention in patients who already have cardiovascular disease.
 
‘We hope that, in time, once appropriate clinical trial evidence emerges, such therapies will also become available for primary prevention in people identified as high risk before they experience an event,’ she said.
 
‘In the meantime, testing remains highly valuable. Identifying high Lp(a) can reclassify a person’s cardiovascular risk profile, prompting earlier and more intensive management of other modifiable risk factors such as LDL-cholesterol, blood pressure, smoking, and diabetes.
 
‘GPs have a crucial role in both ordering the test and guiding preventive strategies that combine medical and lifestyle interventions.’
 
GP and Associate Professor at the University of Melbourne’s Department of General Practice, Ralph Audehm, said identifying these patients early is important.
 
‘We see people who have adverse events, and further events, despite being on good treatment, and so we’re looking at that residual risk – and of course, LP(a) is one of them,’ he told newsGP.
 
‘It’s genetic and puts people at higher risk, but it’s something that hasn’t really penetrated through general practice yet, and it’s not one of our routine tests that we do.
 
‘But it’s important to pick up people who do have it, because they are at a much higher risk. And so certainly, if you have one family member who has it, you should be cascade testing the rest of the family.’
 
Associate Professor Audehm said ‘in patients under 60, and certainly under 50’ who’ve had an event, yet their risk factors are only modest, Lp(a) testing would be worth considering.
 
‘At the moment, we can still treat the traditional risk factors, and that will have an impact – we just need to treat them more aggressively – but when these new treatments come available, it will for these people be a game changer,’ he said.
 
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cardiovascular disease CVD risk heart health