Open AccessLipoprotein‐Associated Phospholipase A 2 : Review and Recommendation of a Clinical Cut Point for Adults
Author(s) -
Lanman Richard B.,
Wolfert Robert L.,
Fleming James K.,
Jaffe Allan S.,
Roberts William L.,
Warnick G. Russell,
McConnell Joseph P.
Publication year - 2006
Publication title -
preventive cardiology
Language(s) - English
Resource type - Journals
eISSN - 1751-7141
pISSN - 1520-037X
DOI - 10.1111/j.1520-037x.2006.05547.x
Subject(s) - medicine , cut point , statistics , mathematics
Recently, several epidemiologic studies have demonstrated an association between plasma lipoprotein‐associated phospholipase A 2 (Lp‐PLA 2 ) concentration and risk of subsequent cardiovascular events. Several major commercial and reference laboratories across the United States are now offering Lp‐PLA 2 testing for clinical use to evaluate cardiovascular risk and as a guide to intensity of therapy in individuals at intermediate risk for developing coronary heart disease. Each laboratory has established its own cut points, or “decision values,” for Lp‐PLA 2 , which vary from the 50th to the 95th percentile values of individual populations tested at each site. Uniform reporting of cut points has not been achieved. The purpose of this manuscript is to recommend appropriate decision values for Lp‐PLA 2 , endorsed by a consensus panel of laboratorians and clinicians from the major laboratories where the test is performed. These coauthors possess considerable experience with assessment of cardiovascular risk marker decision values in general and are familiar with the validation of the Lp‐PLA 2 immunoassay and the Lp‐PLA 2 clinical studies conducted thus far. An ideal risk marker, studied in an ideal population, might yield a consistent cut point associated with a sudden increase in cardiovascular risk. While acknowledging that additional studies will be required to test and refine the recommended decision value, this article reviews the most current information with which to provide guidance to practicing clinicians regarding Lp‐PLA 2 levels. Since several studies have demonstrated increased risk associated with the second and third tertiles vs. the first tertile for Lp‐PLA 2 the 50th percentile cut point (235 ng/mL) is recommended as a conservative cut point associated with increased risk for cardiovascular disease. This cut point is not proposed as a treatment target, but rather as a level above which clinicians should consider a patient to be at higher risk for cardiovascular events, independent of established risk factors, high‐ and low‐density lipoprotein cholesterol, and high‐sensitivity C‐reactive protein.