Lipoprotein(a) testing and levels among patients with atherosclerotic cardiovascular disease: a large single-centre experience from the United Arab Emirates - Report - MDSpire
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Lipoprotein(a) testing and levels among patients with atherosclerotic cardiovascular disease: a large single-centre experience from the United Arab Emirates
Assessment of Lipoprotein(a) Levels in ASCVD Patients in the UAE: A Single-Center Study
Overview
In this retrospective study of 24,025 patients with atherosclerotic cardiovascular disease (ASCVD) in the UAE, only 5.5% underwent lipoprotein(a) [Lp(a)] testing, with 20.9% showing elevated levels (>125 nmol/L). Testing rates were higher in premature ASCVD patients, who also exhibited significantly higher median Lp(a) levels. Patients with elevated Lp(a) were more likely to have comorbidities such as hyperlipidaemia, diabetes, heart failure, and to receive intensified lipid-lowering therapies.
Background
Elevated Lp(a) is a recognized risk factor for cardiovascular events in ASCVD patients and is recommended for testing at least once in adulthood by major guidelines. The Middle East has a high burden of coronary artery disease with earlier onset compared to Western populations, yet data on Lp(a) testing and levels in this region are limited. Understanding Lp(a) distribution and its clinical implications in Middle Eastern ASCVD patients can guide risk stratification and management.
Data Highlights
Parameter
Value
Patients with ASCVD
24,025
Patients tested for Lp(a)
1,333 (5.5%)
Median Lp(a) level
40 [14–108] nmol/L
Patients with Lp(a) >125 nmol/L
20.9%
Patients with Lp(a) >150 nmol/L
17.3%
Patients with Lp(a) ≥200 nmol/L
11.3%
Testing rate in premature ASCVD
7%
Testing rate in non-premature ASCVD
4.4%
Median Lp(a) in premature ASCVD
44 [15.2–113] nmol/L
Median Lp(a) in non-premature ASCVD
36 [12.6–93.8] nmol/L
Increase in testing (2018-2022)
55.8% overall; 75.5% in premature ASCVD
Statin use (tested vs. untested)
75.5% vs. 75%
PCSK9 inhibitor use (tested vs. untested)
16.1% vs. 1.3%
Ezetimibe use (tested vs. untested)
18.8% vs. 9.4%
Key Findings
Only 5.5% of ASCVD patients underwent Lp(a) testing, with higher rates (7%) in premature ASCVD patients.
Median Lp(a) levels were significantly higher in premature ASCVD patients compared to non-premature (44 vs. 36 nmol/L, P < 0.004).
Patients tested for Lp(a) were younger, more often male, and had higher prevalence of hyperlipidaemia, CAD, premature ASCVD, and carotid stenosis.
Higher Lp(a) percentiles correlated with increased rates of hyperlipidaemia, diabetes, heart failure, premature ASCVD, and use of PCSK9 inhibitors and ezetimibe.
Despite guideline recommendations, Lp(a) testing remains underutilized but is increasing over time in this population.
Elevated Lp(a) influenced clinical management, with greater use of advanced lipid-lowering therapies observed post-testing.
Clinical Implications
Routine Lp(a) testing in ASCVD patients, especially those with premature disease, can identify individuals at higher risk who may benefit from intensified lipid-lowering therapy. Increased awareness and adherence to guideline recommendations for Lp(a) measurement could improve risk stratification and management in Middle Eastern populations. Clinicians should consider incorporating Lp(a) testing into secondary prevention protocols to guide therapeutic decisions.
Conclusion
This study highlights the underutilization yet growing adoption of Lp(a) testing in ASCVD patients in the UAE, with elevated levels associated with higher cardiovascular risk and more aggressive lipid-lowering treatment. Enhanced screening strategies are warranted to optimize secondary prevention in this high-risk population.
