The following guidelines include recommendations relevant to cardiovascular disease (CVD)/coronary heart disease (CHD) and Lp-PLA2.
Clinical utility of inflammatory markers and advanced lipoprotein testing: advice from an expert panel of lipid specialists
Davidson MH, Ballantyne CM, Jacobson TA, et al. Clinical utility of inflammatory markers and advanced lipoprotein testing: advice from an expert panel of lipid specialists. J Clin Lipidol. 2011;5(5):338-367.
NLA Biomarkers Expert Panel recommendations:
". . .Lp-PLA2 may be considered in intermediate-risk patients, as well as certain greater-risk subgroups . . . to identify patients who might benefit from more intense lipid therapy."
Lp-PLA2 should be used for the assessment of CHD events and stroke in intermediate- or moderate-risk populations who might be at greater risk than suggested by traditional risk factors, and testing is specifically recommended for the following patients:
- Patients with 2 or more major CHD risk factors
- Patients who are over 65 years of age with 1 additional risk factor
- Patients who smoke
- Patients with elevated fasting glucose
- Patients with diagnostic criteria for metabolic syndrome
Moderate-risk individuals with an Lp-PLA2 level >200 ng/mL should be reclassified as high risk and the LDL-C goal adjusted from <130 mg/dL to <100 mg/dL.
For patients with known CHD or a risk equivalent such as diabetes or stroke, an elevated Lp-PLA2 would place these patients in the very high-risk category; therefore, the LDL goal for these patients is <70 mg/dL.
2010 guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association
Goldstein LB, Bushnell CD, Adams RJ, et al; on behalf of American Heart Association Stroke Council, Council on Cardiovascular Nursing, Council on Epidemiology and Prevention, et al. Guidelines for the primary prevention of stroke: a guideline for healthcare professionals from the American Heart Association/American Stroke Association. Stroke. 2011;42(2):517-584.
Class IIb recommendation:
Lipoprotein-associated phospholipase A2 might be reasonable for cardiovascular risk assessment in intermediate-risk asymptomatic adults (32-35) (level of evidence: B).
2012 American Association of Clinical Endocrinologists guidelines for management of dyslipidemia and prevention of atherosclerosis
Jellinger PS, Smith DA, Mehta AE, et al; for AACE Task Force for Management of Dyslipidemia and Prevention of Atherosclerosis. American Association of Clinical Endocrinologists guidelines for management of dyslipidemia and prevention of atherosclerosis. Endocr Pract. 2012;18(suppl):1-78.
3Q2. Which screening tests are recommended for the detection of cardiovascular risk?
3Q2.8. Additional tests
R26. Assess markers of inflammation in patients where further stratification of risk is necessary. Highly sensitive C-reactive protein (CRP) and Lp-PLA2 provide useful additional information in these instances and appear to be synergistic in predicting risk of CVD and stroke (grade B; BEL 1).
2012 European guidelines on cardiovascular disease prevention in clinical practice
Perk J, De Backer G, Gohlke H, et al; European Association for Cardiovascular Prevention and Rehabilitation (EACPR); ESC Committee for Practice Guidelines (CPG). European guidelines on cardiovascular disease prevention in clinical practice (version 2012). Eur Heart J. 2012;33(13):1635-1701.
Recommendations for thrombotic biomarkers
Class IIb recommendation:
Lp-PLA2 may be measured as part of a refined risk assessment in patients at high risk for a recurrent acute atherothrombotic event.