What is the consensus on the new PLAC test (www.plactest.com) that measures lipoprotein-associated phospholipase A2 (Lp PLA2) for cardiovascular disease/coronary artery disease risk stratification? Are cardiologists, lipidologists, and others using it? How soon are users retesting to evaluate treatment efficacy?
—Colin Soares, PA-C, MPAS, Boise, Idaho
Epidemiologic and laboratory evidence indicate that Lp-PLA2, a biomarker of inflammatory response, is associated with risk of atherosclerosis. Screening is useful to provide incremental predictive values. The PLAC test was recently cleared by the FDA, but current guidelines established by the National Cholesterol Education Program Adult Treatment Panel III do not include measurements of Lp-PLA2. Clinical evidence studies remain controversial. Some studies support a potential role in risk stratification, and others lack sufficient evidence to support that role.
The PLAC test is being performed; however, the ordering clinician must determine whether the test adds to the patient’s best possible outcome. It remains to be determined the extent to which Lp-PLA2-lowering contributes to reducing coronary heart disease beyond the improvement of traditional risk factors (i.e., cholesterol).
Evaluate each patient individually. After baseline and intervention with lifestyle changes or a pharmacologic agent (e.g., a statin or fibrate), the test can be repeated as frequently as every three months until you are satisfied with the results. For more information, see Circulation. 2006;113:1745-1752.
—Debra Kleinschmidt, PhD, PA, RN (114-13)