Aims: Elevated lipoprotein(a) [Lp(a)] is an overlooked and underdiagnosed risk factor for peripheral artery disease (PAD). Negligible testing rates of Lp(a) in patients with PAD are suspected to be largely caused by implementation barriers and poor awareness. Here, we report pilot results of the newly initiated Lp(a)-PAD inpatient care pathway that employs the LILAC-for-Lp(a) framework.

Methods: A review of the process of implementation of the inpatient Lp(a)-PAD pathway was undertaken using quality improvement methods. The prevalence of elevated Lp(a), and its association with the severity of chronic limb ischaemia were investigated.

Results: At 3 months after integrating detection of Lp(a) in the care of patients admitted to hospital for PAD-related limb ischaemia issues, 22.6% of the 106 patients were detected to have elevated Lp(a) levels ≥ 120 nmol/L, and 34.9% with mildly raised Lp(a) ≥ 70 nmol/L. There was a higher proportion of patients with levels ≥ 120 nmol/L compared with Lp(a) < 120 nmol/L who had category 6 classification of chronic limb ischaemia by Rutherford classification (95.8% vs 70.7%, p-value = 0.011). Lp(a) ≥ 120 nmol/L and Lp(a) as a continuous variable were associated with the highest severity of limb ischaemia, p = 0.032 and p = 0.045, respectively. The low-density lipoprotein (LDL) attainment goal in our patients with PAD was suboptimal; LDL-C < 1.4 mmol/L goal attainment was achieved in 30.2% of all patients and 25.0% of the group of elevated Lp(a), respectively.

Conclusion: This pilot study suggests that the LILAC-for-Lp(a) framework, via multidisciplinary collaboration and quality improvement methods, is helpful to integrate Lp(a) testing into PAD management.