A new test to target statins?

Posted on October 8, 2014

In the context of the ongoing – and increasingly sterile – debate about the pros and cons of statins it is refreshing to hear something new.

According to some research presented at a meeting held in Quebec recently it might actually be more sensible to seek to better identify individuals at heightened risk of heart attacks and strokes using a more accurate screening test. Advice and interventions to reduce risks could then be more precisely targeted.

Atherosclerosis

Hardening or furring of the arteries, also known as atherosclerosis, is due to the accumulation of calcium and cholesterol in plaques on artery walls. Moreover there are two broad categories of atherosclerotic plaques: stable and unstable (or vulnerable). Unstable plaques are more likely to rupture causing a blood clot that blocks the supply of blood to the heart – triggering a heart attack; or the brain – triggering a stroke.

Currently, assessing an individual`s stroke or heart attack risk  relies heavily on computer programmes that grade people according to a number of features including age, sex, ethnicity, cholesterol level, blood pressure, smoking status and family history. But a number of studies have shown that one in five individuals having had a heart attack might not have been assessed as being at high or moderate risk using the currently available computer programmes before the heart attack occurred.

A simple blood test could help…

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an enzyme that seems to have a role in the progression of early, relatively stable atherosclerotic plaques to unstable rupture-prone plaques.  Moreover high levels of Lp-PLA2 are present in unstable rupture-prone plaques and it appears that Lp-PLA2 is released from these plaques into the circulation where it`s levels can then be measured by a simple blood test.

The Lp-PLA2 blood test has now been approved by the United States Food and Drug Administration (FDA) for assessing the risk of stroke and coronary artery disease and has also recently become available in the UK.

It is suggested that Individuals with a raised Lp-PLA2 result might be just the group that should be the major target group for treatment with statins in order to lower their risks. Moreover as the current approach to commencing treatment is stains is somewhat arbitrary –  ignoring the linear correlation between heart attacks and cholesterol levels  – it is further proposed that if the Lp-PLA2 result is high statin treatment should be considered even if a person has been told that their cholesterol reading is `normal`.