Patient views 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) all patients with elevated (E)Lp(a) 50mg/dl (115nmol/l) and a random sample of patients with normal (N)Lp(a) were identified. Purpose To elicit patient views on CVD knowledge, Lp(a) testing, consequences and treatment. Methods Patients with ELp(a) were informed of their result, given Lp(a) information and advised to see their own physician. All patients with ELp(a) and NLp(a) were interviewed by telephone by trained research assistants in national languages using specially developed questionnaires. Results 856 patients (333 ELp(a) and 523 NLp(a)), mean age 60.2 (10.5), were interviewed. Taking a statin after a heart attack was thought to reduce risk in 78.7% ELp(a) and 79.2% NLp(a) (p=0.85) respectively, although 31.8% ELp(a) and 32.7% NLp(a) (p=0.82) thought statins are commonly associated with serious side effects. An LDL-C target of 1.4 mmol/l (55 mg/dl) was considered true in 42.9% ELp(a) and 55.8% NLp(a) (p=0.0004). 32.1 % ELp(a) patients vs 25.6% NLp(a) (p=0.0056) thought their level was inherited and 57.4% ELp(a) vs 52.0% NLp(a) (p=0.0002) thought it could be modified by lifestyle. 69.4% ELp(a) vs 53.5% NLp(a) (p0.0001) thought it increases heart attack risk and 64.0%ELp(a) vs 58.5% NLp(a) (p0.0001) thought it can be reduced by medication. 95% ELp(a) agreed that getting their result was good, and 90% thought close relatives should be tested. Although no drug treatment is currently licensed to lower Lp(a) 92% ELp(a) considered that a Lp(a) result encourages further efforts to reduce their own CVD risk. Almost all patients with ELp(a) and NLp(a) wanted professional support to reduce their risk of a heart attack in the future. Conclusion Patients with coronary disease and ELp(a) thought receiving their Lp(a) result was good, and their close relatives should also be tested. Most were unaware that it is inherited, cannot be modified by lifestyle and thought it can be reduced by medication. Almost all patients thought their Lp(a) result encouraged them to make further efforts to reduce their overall CVD risk.