Sep. 4, 2024

Global Insights from the INTERASPIRE Study: Mapping Lipoprotein(a) Prevalence in Coronary Heart Disease Across Six WHO Regions

The International INTERASPIRE study provides important insights for primary care providers regarding the prevalence and impact of elevated Lipoprotein(a) [Lp(a)] levels in patients with coronary heart disease (CHD) across various regions

Here’s how the study’s findings are relevant to primary care

Main Results

1. Prevalence of Elevated Lp(a) in CHD Patients

• Primary Care Action: The study showed that nearly 20% of CHD patients had elevated Lp(a) levels (≥115 nmol/L), with significant variability between regions and countries. This highlights the importance of measuring Lp(a) levels in primary care, especially for newly diagnosed CHD patients or those at high risk.
• Implication: Primary care providers should consider including Lp(a) screening in routine care for CHD patients to better assess cardiovascular risk, particularly when other risk factors are controlled but cardiovascular risk remains high.

2. High-Risk Groups Identified

• Primary Care Action: Higher Lp(a) levels were found in specific subgroups, including women, patients with chronic kidney disease, peripheral arterial disease, and those on PCSK9 inhibitors.
• Implication: For high-risk populations (e.g., women and those with chronic conditions), primary care physicians should be especially vigilant about monitoring Lp(a) and implementing aggressive risk factor management.

3. Lifestyle and Risk Factor Management Gaps

• Primary Care Action: The study revealed substantial gaps in lifestyle and risk factor management, with only 1.8% of patients with Lp(a) ≥115 nmol/L achieving an entirely healthy lifestyle. Key gaps included: - 39.5% engaged in regular physical activity, 32% had a BMI under 25, only 29.4% had optimal LDL-C levels.
• Implication: Primary care must emphasize lifestyle interventions such as smoking cessation, weight management, and physical activity as part of ongoing care for CHD patients. Regular counseling and follow-up to ensure patients are meeting lifestyle and health metrics is essential to reduce their cardiovascular risk.

4. Managing Other Cardiovascular Risk Factors

• Primary Care Action: Blood pressure, HbA1c, and fasting glucose control were found to be suboptimal in many patients. Around 66.7% of patients had controlled blood pressure, and 53.4% had adequate glycemic control.
• Implication: For primary care providers, controlling blood pressure and blood sugar levels in CHD patients is crucial, particularly in those with elevated Lp(a). Better management of these risk factors can help reduce overall cardiovascular risk.

5. Global Variability and Equity in Secondary Prevention

• Primary Care Action: The study pointed to global variability in the care provided to CHD patients. Primary care providers should be aware of these regional differences and work to ensure equitable access to secondary prevention strategies, including lifestyle interventions, medications, and monitoring.
• Implication: Advocacy for health system improvements and resources for CHD prevention at the primary care level is essential. Collaboration with specialists and policymakers can help bridge gaps in care and improve outcomes for patients with elevated Lp(a) and CHD

Conclusion

The INTERASPIRE study highlights the need for primary care providers to actively screen for and manage elevated Lp(a) in CHD patients while addressing lifestyle and modifiable risk factors. Closing gaps in lifestyle interventions, ensuring proper control of blood pressure and glucose, and advocating for equitable healthcare access are critical steps in reducing the global burden of coronary heart disease.

Disclosures

This information is based on presentation held at ESC 2024. GPcardio is not responsible for potential misinterpretations of the data