ASCVD and Lp(a) assessment

March-April 2024

LCN Lp(a) survey 2024 (Novartis support) (#89)

Background
Status quo
Utility
Outlook

A survey among the EAS Lipid Clinics Network.

We invite members of the EAS Lipid Clinic Network to complete this survey, and to disseminate it among their clinical colleagues.

We are interested in knowing the views of clinicians working in lipid clinics about evaluation of Lp(a), how it is managed and its relevance to your practice today, and whether or how you see that changing in the future.

Your answers will help us understand the challenges and barriers to evaluation of Lp(a) in clinical practice.

The survey will take no more than 6 minutes. Please submit your response by April 12, 2024.

Thank you.

Background information

About you and your clinical practice environment.

0.1: In which country do you practice?

0.2: In which clinical setting do you practice?

University hospital

Other specialist hospital

General hospital

Private practice

Other (please specify)

Please specify your clinical setting if it is not given above

0.2a: What is the size of your hospital?

<100 beds

100-500 beds

500-1,000 beds

>1,000 beds

0.3: What is your speciality?

Cardiology

Endocrinology

Lipidology

Neurology

Other (please specify)

Please give your specialty, if it is not given above

0.4: Is Lp(a) testing reimbursed for hospital patients in your hospital?

Yes

I do not know

0.5: Is Lp(a) testing reimbursed for your outpatients?

Yes

I do not know

Part-1: Status-quo of Lp(a) testing

About how Lp(a) is currently measured in your clinical setting.

1.1: It is easy for me to routinely measure Lp(a)

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

1.2: I measure Lp(a) in all my ASCVD patients

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

1.3: I measure Lp(a) in all patients for cardiovascular risk assessment

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

1.4: I only test Lp(a) in certain patient types. Please choose one or more answers:

ASCVD patients with a prior event

ASCVD patients without a prior acute event

Patients with a recent cardiovascular event (MI, stroke)

Patients with premature ASCVD

Patient with a family history of ASCVD

Patients with poor response to LLT

I do not test for Lp(a)

I test Lp(a) in all patient types

1.5: Does your clinic have standardized protocols for routine Lp(a) testing?

Yes

No, doctors decide individually on Lp(a) testing

Patients are not tested for Lp(a) testing in my clinic

I do not know

1.5a: How is routine Lp(a) testing standardized? Please choose one or more answers:

There are standard protocols ensuring routine Lp(a) testing

Lp(a) is part of standard lab panel for CV risk assessment

Lp(a) status is captured as part of the diagnosis

1.6: What proportion of your patients with a new ASCVD diagnosis receive an Lp(a) measurement?

0-25%

26-50%

51-75%

76-99%

100%

1.7: What is the most important reason for you NOT to test for Lp(a) routinely? Please choose one or more answers:

Cost

Time

Test result has no impact on risk assessment

Test result has no impact on treatment decisions

Test result is difficult to explain to the patient

1.8: Which units of measurement are used when reporting cut-off values in your clinical laboratory?

mg/dL

nmol/L

My lab does not indicate levels as normal or elevated

What is the cut-off value in mg/dL for the Lp(a) level that your clinical laboratory considers as NORMAL?

What is the cut-off value in mg/dL for the Lp(a) level that your clinical laboratory considers as ELEVATED?

What is the cut-off value in nmol/L for the Lp(a) level that your clinical laboratory considers as NORMAL?

What is the cut-off value in nmol/L for the Lp(a) level that your clinical laboratory considers as ELEVATED?

Part 2: Utility of Lp(a) testing

How you view the value of evaluating Lp(a) in your current environment.

2.1: I believe that routine Lp(a) testing provides clinical value in my practice

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

2.2: What are important reasons to test for Lp(a) in your clinical practice? Please choose one or more answers:

It is part of standard protocols

It is part of standard CV risk assessment

The test result can explain the disease history of the patient and their family

The test result can inform treatment intensification

The test result can motivate treatment adherence and lifestyle optimization of the patient

Patients ask for Lp(a) testing

2.3: What do you do when you see elevated Lp(a) test results? Please choose one or more answers:

Explain the results of the Lp(a) test to my patient

Test family members

Advise lifestyle changes

Intensify global risk factor management

Refer to a colleague specialized in Lp(a)

I do not act upon it

2.4: Routinely testing for Lp(a) has helped me to get a more complete understanding of my ASCVD patients

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

2.5: Patients are more motivated to adhere to treatments and lifestyle advice when knowing about their elevated Lp(a) and its implications

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

2.6: Do you use the ASCVD risk simulator (Lp(a) Clinical Guidance calculator) provided by EAS to take into account Lp(a) values in overall CVD risk evaluation?

Yes, for my own use

Yes, in discussion with the patient

No, though I am aware of this tool

No, I was not aware of this tool

Part-3: Outlook on Lp(a) testing

How you see evaluation of Lp(a) in your clinical environment changing in the future.

3.1: I feel confident to test Lp(a) routinely in the future

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

3.2: I feel motivated to test Lp(a) routinely in the future

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

3.3: In your opinion, which of these initiatives will help to increase general adoption of routine Lp(a) testing? Please choose one or more answers:

Broader HCP education on Lp(a) and the benefits of Lp(a) testing

Patient education on Lp(a) and the benefits of Lp(a) testing

Adoption of standardized protocols for Lp(a) testing within clinics/practices

Standardized inclusion of Lp(a) in lipid panels

Lowering the cost of testing

Availability of Lp(a) targeting therapies

3.4: I think that in the future, Lp(a) testing should be performed in every individual as part of the CV risk assessment if the trials with anti-(a) siRNA fail to evidence MACE risk reduction

Strongly agree

Agree

Neutral

Disagree

Strongly disagree

3.5: I think that in the future, Lp(a) testing should be performed in every individual as part of the CV risk assessment if the trials with anti-(a) siRNA evidence MACE risk reduction

Strongly agree

Agree

Neutral

Disagree

Strongly disagree