Physician perspectives on lipoprotein (a) testing and treatment for secondary prevention of cardiovascular disease - results from 7 countries across 6 WHO regions from the INTERASPIRE study

Abstract Background Lipoprotein (a) [Lp(a)] is a genetic causal risk factor for cardiovascular disease (CVD). Lp(a) was measured in 3928 patients with coronary disease from 13 countries in INTERASPIRE. In a sub-study in 7 countries (China, Colombia, Kenya, Nigeria, Malaysia, Poland, UAE) physicians were contacted from the study hospitals to get their perspectives on lipid management in patients with coronary artery disease. Purpose The objective was to elicit physician views on lipid and Lp(a) testing and treatment. Methods A sample of physicians - cardiologists, general physicians and lipid specialists - were interviewed by telephone by trained research assistants in national languages using a specially developed questionnaire. Results 245 physicians were interviewed; 55% cardiologists, 28% general physicians, 17% lipid specialists. 58.4% used Joint European Guidelines on dyslipidaemias and 41.2% used USA guidelines. In patients with coronary disease 69.7% try to achieve the LDL-C target of < 1.4 mmol/l (55 mg/dl) and cardiologists are more intensive about goal attainment than lipid specialists and general physicians. 58.4% chose atorvastatin and 40.4% rosuvastatin as their first choice of statin. 42.9% could request Lp(a) measurement but, of these, only 49.5% measured it routinely. Physicians were most likely to request Lp(a) testing in patients with premature (< 55 years male < 65 years female) coronary artery disease (91%), patients with a second or recurrent coronary (STEMI/NSTEMI) event (81%) and in those with first degree relatives with high Lp(a) (82%). 56.2% received Lp(a) results in mass units. An elevated Lp(a) was defined variably, most commonly >50 mg/dl by 24.5%, and 31.8% were unsure or did not know. 94.2% believed that Lp(a) testing was beneficial and 80.8% would advise testing of first degree relatives. Conclusion Most physicians use European or American guidelines on management of dyslipidaemias. A large majority try to achieve a lower LDL-C target by using high intensity statins, especially the cardiologists. There is marked heterogeneity in access to Lp(a) testing for physicians and where it is available less than half measure it routinely in patients with coronary disease. Interpretation of an elevated Lp(a) varies widely and about one third of physicians were unsure or did not know. Yet most physicians believe that Lp(a) testing would benefit patients and their relatives.