Table 1.

Search concepts and excerpts of readable and nonreadable quotes from OPEM.

Concept	Excerpt from less readable OPEMa	Excerpt from more readable OPEM
Lp(a)b contains both a lipid and a protein carrier	“Lipoprotein(a), or Lp(a), is a distinctive particle with two components: a lipoprotein core that resembles LDL, along with a shell that contains apolipoprotein(a), or apo(a).” [22]	“Lipoproteins are substances made up of protein and fat” [23]
Lp(a) is a proatherogenic lipoprotein fraction	“High levels of LP(a) have now been identified as an independent risk factor in cardiovascular disease, with a causal link to atherosclerosis (furring up of arteries), heart attacks, strokes, aortic valve disease and heart failure.” [24]	“High levels of Lp(a) can create plaque in your blood vessels.” [25]
High-risk populations should be screened for Lp(a)	“Measurement of lipoprotein(a) is now recommended in several patient subgroups… patients with premature atherosclerosis; patients with a strong family history of premature coronary heart disease (CHD); patients with elevated LDL-C and greater than or equal to two risk factors; patients who have had coronary angioplasty in whom lipoprotein(a) excess may increase the risk of restenosis; patients who have undergone coronary bypass graft surgery in whom Lp(a) excess may be associated with graft stenosis.” [26]	“You may need this test if you have: Heart disease, despite normal results on other lipid tests, High cholesterol, despite maintaining a healthy diet A family history of heart disease, especially heart disease that has occurred at an early age and/or sudden deaths from heart disease.” [27]
There is no widely implemented standard for measuring Lp(a)	“Although the reference material for the accurate measurement of Lp(a) … has been available for many years, many commercial laboratories have not changed their reagents and testing methods and continue to use old reagents and methods resulting in inaccurate results. Accordingly, results of Lp(a) measurements by different labs are not comparable and some of them are clearly inaccurate.” [28]	“Note: Normal value ranges may vary slightly among different laboratories. Talk to your doctor about the meaning of your specific test results.” [29]
There are no drugs demonstrated to improve outcomes in patients with elevated Lp(a)	“Results using statin medications have been mixed in most trials … In severe cases, such as familial hypercholesterolemia or treatment- resistant hypercholesterolemia, lipid apheresis may dramatically reduce Lp(a) … Other medications that are in various stages of development include thyromimetics, cholesterol-ester-transfer protein (CETP inhibitors), anti-sense oligonucleopeptides, and proprotein convertase subtilisin/kexin type 9 (PCSK-9) inhibitors.” [30]	“Medications/treatments in current use that lower Lp(a) also lower cholesterol. There are apheresis and niacin. These both have substantial side effects. PCSK9 inhibitors lower Lp(a) while lowering LDL cholesterol. Statins have no effect on Lp(a).” [31]

^aOPEM: online patient educational material.

^bLp(a): lipoprotein(a).