Case:
Mapping Emerging Diagnostic Strategies in Cardiovascular Risk Assessment

Cardiovascular disease remains one of the leading causes of mortality worldwide. Lipoprotein(a) [Lp(a)], an inherited genetic risk factor for cardiovascular disease, holds significant potential as a target for future therapies. Yet, routine testing of Lp(a) in clinical practice is underutilized and poorly understood.

We conducted a comprehensive analysis of Lipoprotein(a) testing patterns in Denmark, providing critical insights into emerging cardiovascular risk assessment strategies.

Project Overview

• Investigated comprehensive trends in Lipoprotein(a) testing across the Danish healthcare system
• Analyzed testing behaviors across different regions and healthcare specialties
• Examined patient demographics and testing frequencies from 2013 to 2024
• Identified key patterns in cardiovascular risk screening practices
• Insights set the stage for better awareness, earlier diagnosis, and expanded testing.

The Challenge

Despite its significance in cardiovascular risk assessment, Lp(a) testing remains far from standard practice in Denmark. By 2024, only 8.8% of 261,649 patients diagnosed with atherosclerotic cardiovascular disease (ASCVD) had undergone Lp(a) testing.

Our client recognized the emerging significance of Lipoprotein(a) as a critical cardiovascular risk factor but faced substantial uncertainties in understanding its current clinical utilization. The company needed comprehensive insights into:

• Detailed patterns of Lp(a) testing across different regions
• Reasons behind low testing rates among ASCVD patients
• The role of hospital specialists in diagnostic practices
• Potential strategies for improving early risk detection
• Detailed patient demographic patterns related to testing

Rikke Færgemann Hansen, RWD lead at Signum, captured the essence of this challenge: “Understanding Lp(a) testing starts with identifying critical gaps in our current approach to cardiovascular risk assessment and creating pathways for more precise diagnostic strategies.”

Most tests were requested by hospital specialists, predominantly cardiologists, which created a notable gap in early detection, especially for patients outside specialized hospital settings.

The Solution

We leveraged our unique capabilities in combining quantitative data from multiple national health registers to provide an unprecedented view of Lp(a) testing trends. Our analysis drew from nationwide data sources, including the Danish Health Data Authority and Statistics Denmark, enabling a robust and comprehensive investigation.

“What makes our approach unique is our ability to connect multiple data points, transforming raw information into actionable insights,” Rikke observes.

To uncover these insights, we conducted a comprehensive analysis that revealed several critical findings across different dimensions of Lp(a) testing in Denmark.

Testing Landscape

In total, 57,561 patients were tested for Lp(a) between 2013-2024 with the majority being men (59.8%) and an average first-test age of 59 years. The analysis revealed a remarkable 256% increase in tested individuals from 2018 to 2024.

Regional Variations

Testing patterns varied dramatically across Danish regions. The Capital Region and Region Zealand demonstrated the highest testing rates, while Southern Denmark, Central Denmark, and North Jutland showed distinctive testing behaviors. Between 0.7% and 1.3% of each region’s population underwent Lp(a) testing.

Specialist Involvement

Nearly 99% of Lp(a) tests were requested by hospital specialists, with cardiologists accounting for the majority of tests. Cardiology emerged as the only department showing a clear increase in test requests throughout the study period.

Patient Populations

By 2024, 8.8% of atherosclerotic cardiovascular disease (ASCVD) patients had undergone Lp(a) testing. Myocardial infarction patients demonstrated the highest likelihood of being tested, with noticeable variations in testing rates across different cardiovascular conditions.