Objective:

To evaluate the utilization and clinical implications of Lp(a) testing among patients with atherosclerotic cardiovascular disease (ASCVD) in the UAE.

Key Findings:

• Only 5.5% of ASCVD patients had Lp(a) tested, with a median level of 40 nmol/L, indicating significant underutilization.
• 20.9% of tested patients had abnormal Lp(a>125 nmol/L); 11.3% had levels ≥200 nmol/L, highlighting the need for increased testing.
• Testing rates were higher in patients with premature ASCVD (7% vs. 4.4%), suggesting a targeted approach may be beneficial.
• Patients tested for Lp(a) were younger, more often male, and had a higher prevalence of hyperlipidaemia and CAD, indicating a specific demographic at risk.
• There was a significant increase in Lp(a) testing rates over time, particularly in the premature ASCVD subgroup, reflecting growing awareness.

Interpretation:

Despite low overall testing rates, the study indicates a growing awareness of Lp(a) testing's utility in high-risk ASCVD populations, with significant associations between elevated Lp(a) levels and adverse cardiovascular conditions, underscoring the need for clinical action.

Limitations:

• Single-centre, retrospective design limits generalizability and may not reflect broader population trends.
• Potential selection bias may have influenced findings, as testing was at physician discretion.
• Did not differentiate between patients already on lipid-lowering therapy and those newly initiated, which could affect Lp(a) levels.

Conclusion:

The study highlights the underutilization of Lp(a) testing in ASCVD patients, emphasizing the need for clinical decision-making improvements and further research on long-term outcomes associated with elevated Lp(a).