OBJECTIVES : Lipoprotein(a) [Lp(a)] is an inherited, independent and causal risk factor for atherosclerotic cardiovascular disease (ASCVD). A systematic assessment of evidence on Lp(a) from literature is lacking. We aim to describe the distribution of Lp(a) in secondary prevention ASCVD patients among geographies.

METHODS : A systematic literature review was conducted using Embase®, MEDLINE® and MEDLINE®-In Process databases to identify data on secondary prevention ASCVD patients published from 2010 to September 2020. Studies were included if they had ≥1 Lp(a) assessments, ≥500 patients, published in English as the full-text articles.

RESULTS : A total of 5,145 publications were retrieved, 64 studies were included (major exclusion reasons included other diseases, primary ASCVD prevention, reviews/pre-clinical, patients <500). The included studies were mainly published between 2018 and 2020 (61%; n=39); 45% from Asia (n=29), 31% from Europe (n=20); and 48% were of prospective observational design (n=31). According to three studies, Lp(a) was measured more frequently in patients after an ASCVD event or with premature-onset of ASCVD compared with those prior to an event or in late-onset of ASCVD. Different Lp(a) cut-offs were reported in studies across geographies. The prevalence of Lp(a) ≥50 mg/dL (elevated) in ASCVD patients ranged from 13–29%: 20–29% in the US (n=6), 18–20% in the UK (n=2), 17–20% in Germany (n=4), 25% in Spain (n=3), 19–20% in the Netherlands (n=2), 26% in Denmark (n=1), 30% in Austria (n=1), 16% in Greece (n=2), 26% in Australia (n=1), 16% in China (n=20) and 13% in Japan (n=4).

CONCLUSIONS : Epidemiological research in Lp(a) in an ASCVD population has gained interest over the last few years. This review confirms that Lp(a) is elevated in 1 in 5 patients with ASCVD. Given that Lp(a) is associated with ASCVD risk, its testing in clinical practice should be performed more frequently as part of a comprehensive lipid and risk profile.