Journal Watch Cardiology July 18, 2012JoAnne M. Foody, MDA pooled analysis provides no justification for routinely adding any new tests to current lipid panels.
During the past decade, a myriad of new lipid biomarkers have been purported to correlate better than traditional lipid measures with cardiovascular risk. To assess the value of these novel biomarkers for routine use in risk prediction, investigators pooled data from 37 cohorts including more than 165,000 individuals with a median follow-up of 10 years.
The combination of
apolipoprotein B (apoB) and
apolipoprotein A-I (apoA-I),
lipoprotein(a) (Lp[a]), and
lipoprotein-associated phospholipase A2 (Lp-PLA2) all performed worse than total cholesterol and HDL at predicting cardiovascular risk, and adding the newer markers to conventional risk factors improved risk prediction only slightly. By the authors' estimate, 13,622 of every 100,000 adults aged 40 or older would be classified at intermediate risk by conventional risk factors alone; the addition of combined apoB and apoA-I, Lp(a), or Lp-PLA2 would reclassify 1.1%, 4.1%, and 2.7%, respectively, to high risk. The estimated numbers requiring screening to prevent one cardiovascular event over 10 years were about 4500 for combined apoB and apoA-I, 800 for Lp(a), and 1000 for Lp-PLA2.
Comment: This study, the largest to date, suggests that novel lipid biomarkers add little incremental value to traditional lipid measures for risk prediction — the predictive power of lipoprotein(a), the best of the markers studied, was not good enough to recommend routine testing. Clinicians should reserve these tests for patients in whom conventional risk factors might not fully inform risk assessment or treatment decisions — for example, those with a strong family history of premature cardiovascular disease.
Citation(s):
The Emerging Risk Factors Collaboration. Lipid-related markers and cardiovascular disease prediction. JAMA 2012 Jun 20; 307:2499.
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