Lipoprotein(a) [Lp(a)] is recognised as an independent, non-modifiable genetic risk factor for cardiovascular (CV) disease. Current guidelines from the European Society of Cardiology (ESC) and the European Atherosclerosis Society (EAS) recommend that Lp(a) be measured at least once in every adult's lifetime, however routine Lp(a) testing rates remains infrequent.

The aim of this study is to assess the impact of implementation strategies (IStr) designed to increase the adoption of Lp(a) testing in routine practice, ultimately leading to more individuals being tested in secondary care. This, in turn, is expected to result in the identification and enhanced management of Cardiovascular Disease (CVD) risk patients with elevated Lp(a).

Inclusion Criteria:

Each cluster within this study has a set of inclusion criteria. In addition, to be eligible for inclusion in this study, all the following criteria at the cluster-level must be met:

Inclusion criteria for centers:

1. Lp(a) testing is available in this center and reimbursed.
2. Capacity to increase Lp(a) testing in relevant patient groups (according to the defined patient eligibility criteria).
3. Low and/or inconsistent Lp(a) testing rate(number of eligible patients tested for Lp(a)/number of eligible patients seen) <15%.
4. Willingness to fulfill research requirements, e.g., repurposing existing clinic data for research etc.
5. Seeing a defined number of eligible patients per year based on the sample size required for the study.
6. Availability of local infrastructure and data interoperability.

Inclusion criteria for HCP survey participants:

1. CV specialists or other HCPs managing and accessing CV risk at their respective centers (cardiology units or equivalent).

Electronic records are eligible for assessment in this study if they meet all the following criteria:

1. ICF and/or ICF waiver will be sought prior to abstraction of electronic patient records.

2. Patients attending at least one SOC visit during the pre-defined time intervals (12 months prior to index date and 0-6 months, 7-12 months and 13-24 months post-index).

3. Previous Lp(a) testing:

   1. Patients with an Lp(a) test recorded before the index date will be included in the baseline assessment, which covers the 12 months prior to the index date.
   2. For post-index assessments at 6-, 12- and 24-months after the index date, patients with an Lp(a) test recorded before the index date will be excluded.

4. Over 18 years of age and qualify for Lp(a) testing according to local practice.

Exclusion Criteria:

Exclusion criteria at center cluster-level includes:

1. Centers with no access to Lp(a) testing.
2. Centers where Lp(a) testing is not reimbursed.

Electronic records will not be assessed for:

1. Patients that have undergone Lp(a) testing prior to index date (for the post-index assessment)

cardiology centers (or equivalent) with low or inconsistent Lp(a) testing in Germany, Italy and the UK