NOVEL AND EFFECTIVE TESTING FOR PREDICTION OF CORONARY HEART DISEASE

LIPOPROTEIN-ASSOCIATED PHOSPHOLIPASE A2 (LP-PLA2) ACTIVITY

C A R D I O L O G Y A T M A Y O C L I N I C

M A Y O M E D I C A L L A B O R A T O R I E S . C O M / C A R D I O L O G Y

A NOVEL AND EFFECTIVE TEST FOR CHD PREDICTION

} Novel risk prediction of CHD in patients with no prior history of cardiovascular events

} Prognostic value independent of standard lipid profile testing

} Validated in thousands of patients in multicenter substudy using a cutpoint of 225 nmol/min/mL

} Avoids lot-to-lot variability and preanalytical issues found in previous version of test (commonly referred to as “mass” assay)

ENHANCED CARDIOVASCULAR RISK ASSESSMENT FROM MAYO CLINIC

Lipoprotein-associated phospholipase A2

(Lp-PLA2) is an inflammatory protein produced

in the vascular intima and is highly upregulated

in atherosclerotic plaques, especially within the

necrotic core and macrophages surrounding

vulnerable plaques. It circulates bound to low

density lipoproteins and, to a lesser extent, high

density lipoproteins. Patients with higher plaque

burden have higher circulating Lp-PLA2.

Individuals with increased Lp-PLA2 (PLAC)

activity are at higher risk of coronary heart

disease events and stroke. In one population-

based study using the REGARDS* cohort,

individuals with ≥ 225 nmol/min/mL were at

increased risk of coronary heart disease (CHD)

events.1

Recently, elevated Lp-PLA2 activity was found

to associate with faster stenosis progression

in patients with mild aortic stenosis.2

Assessing patient risk of CHD events remains a

challenge in primary prevention. In fact, patients

with low to moderate CHD risk still have a

significant risk of events over 10 years.3

When assessing CHD risk, cholesterol testing

alone is not always enough.4

Fig. 1

TOTAL CHD EVENT RATES1

Fig. 2

PLAC ACTIVITY PREDICTION OF CHD EVENTS1

8 0 0 - 5 3 3 - 1 7 1 0 o r + 5 0 7 - 2 6 6 - 5 7 0 0

L P - P L A 2 T E S T I N G

WHICH TEST SHOULD I ORDER?} Lipoprotein-Associated Phospholipase A2 Activity,

Serum (Mayo ID: PLACA)

WHEN SHOULD I ORDER?} Identify persons at increased risk for CHD events

} Predict novel risk of CHD in patients with no prior history of cardiovascular events

} Obtain a prognostic value independent of standard lipid profile testing

} For use in conjunction with clinical evaluation and patient risk assessment

DEMONSTRATED ACROSS MULTIPLE CLINICAL TRIALS AND PATIENT POPULATIONS} The greater the Lp-PLA2 Activity, the greater the risk of fatal and non-fatal CHD events Fig. 3

} PLAC Activity above 225 identifies patients at increased risk of CHD events across patient type and population Fig. 4

} Absolute risk of CHD events is 2.1 times greater with a positive PLAC Test Fig. 4

All graphs adapted from “When Assessing Your Patient Risk for Coronary Heart Disease ...” educational booklet. Used with permission from diaDexus, Inc, San Francisco, CA.

* REasons for Geographic And Racial Differences in Stroke

LP-PLA2 ACTIVITY & CHD* RISK5

Fig. 3

RATES OF CHD EVENT RATES BY PATIENT TYPES6

Fig. 4

MC2775-105rev0815

@mayocliniclabs/mayocliniclabsnews.mayomedicallaboratories.commayomedicallaboratories.com

DIRECTORS1 LINNEA BAUDHUIN, PH.D.2 LESLIE DONATO, PH.D.3 ALLAN JAFFE, M.D.4 JOSEPH MALESZEWSKI, M.D.5 JEFF MEEUSEN, PH.D.

1 2 3

5

TAP INTO THE EXPERTISE OF MAYO CLINIC

The Cardiovascular Laboratory Medicine Group

within Mayo Clinic works to accommodate the

growing demand for development, validation, and

use of analytes to predict risk for both primary and

secondary prevention.

Focused on acute-care cardiology, risk

stratification, and genomics, the group integrates

laboratory cardiology with its colleagues in

cardiology, pediatric cardiology, genetics,

cardio-thoracic and vascular surgery—as well as

cerebrovascular specialists in neurology.

FOR MORE INFORMATION ABOUT CARDIOVASCULAR TESTING, VISITMayoMedicalLaboratories.com/cardiology

4

1 2

CARDIOLOGY-FOCUSED GENETIC COUNSELORS1 MICHELLE KLUGE, M.S., CGC2 KATE KOTZER, M.S., CGC

REFERENCES

1. The PLAC Test for Lp-PLA2 Activity Package Insert.

2. Capoulade R, Mahmut A, Tastet L, et al: Impact of plasma Lp-PLA2 activity on the progression of aortic stenosis: the PROGRESSA study. JACC Cardiovasc Imaging 2015 Jan;8(1):26-33

3. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. JAMA 2001;285:2486-2497

4. Final Recommendation Statement: Lipid Disorders in Adults (Cholesterol, Dyslipidemia): Screening. U.S. Preventive Services Task Force. December 2014. http://www.uspreventiveservicestaskforce.org/Page/Document/RecommendationStatementFinal/lipid-disorders-in-adults-cholesterol-dyslipidemia-screening

5. Thompson, A. et al. Lancet 2010; 375:1536-44

6. Adapted from the PLAC Test for Lp-PLA2 Activity Package Insert