P250 - CHARACTERIZING LIPOPROTEIN(A) TESTING AND CONCENTRATIONS IN CANADIANS WITH CARDIOVASCULAR DISEASE: BASELINE RESULTS FROM THE LIPOPROTEIN(A) AWARENESS PROGRAM

Background: Lipoprotein(a) [Lp(a)] is a genetically determined, independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Despite strong recommendations from Canadian and international guidelines to measure Lp(a) at least once in a lifetime, testing remains inconsistently implemented in clinical practice. The objective of this study was to assess the prevalence of elevated Lp(a) in individuals with ASCVD from Ontario and Quebec managed by community-based physicians, and investigate demographic and clinical profiles as part of the LipoprotEin(a)wareness Program [LE(a)P].

METHODS AND RESULTS: LE(a)P is a multi-center, observational, quality improvement initiative led by the Canadian Heart Research Centre. Participating clinicians retrospectively identified consecutive adults (≥18 years) with established ASCVD. De-identified data were extracted via chart review. Lp(a) values, if available, were categorized as desirable ( < 30 mg/dL or < 75 nmol/L), borderline (30–49 mg/dL or 75-99 nmol/L), or elevated (>50 mg/dL or >100 nmol/L). Patient characteristics were summarized using descriptive statistics. As of May 2025, data were collected for 789 ASCVD patients across Ontario and Quebec. The median age was 70 (63-77) years with 27% females. Among them, 42% had percutaneous coronary intervention, 27% coronary artery bypass surgery, 6% ischemic stroke, and 7% symptomatic peripheral artery disease. Common comorbidities included hypertension (68%), diabetes (38%), and familial hypercholesterolemia (7%). Median LDL-C was 1.5 mmol/L (1.2-2.0) and apolipoprotein-B 0.7 g/L (0.5-0.8), with a large proportion treated with statins (92%), ezetimibe (39%), and/or a PCSK9-inhibitors (11%). Lp(a) measurement was documented in 440 patients (56%), of whom 265 (60%) and 238 (54%) had levels ≥30 mg/dL and ≥50 mg/dL, respectively. Of those with elevated Lp(a), 58% had a history of acute coronary syndrome, including 86% with prior myocardial infarction. In this group, 75% underwent intensive management of other risk factors, 70% received lifestyle advice, and 57% had their lipid-lowering therapy intensified; only 5% had no care changes. Among 53 participating physicians, 79% correctly identified guideline-based thresholds for elevated Lp(a), with lack of therapeutic options being the most frequently reported barrier to routine testing.

Conclusion: In this real-world Canadian cohort, Lp(a) testing was performed in just over half of ASCVD cases. Elevated Lp(a) was common and often co-existed with other high-risk cardiovascular conditions. Among those with elevated levels, most received intensified risk factor management or lifestyle counseling, though referrals to Lp(a) specialists were rare. These findings underscore persistent gaps in testing and practice variability, and highlight the need for clearer clinical pathways and therapeutic strategies to optimize care for patients with elevated Lp(a).