BlueCross BlueShield of Tennessee Medical Policy Manual

Genetic Testing for Lipoprotein(a) Variant(s) as a Decision Aid for Aspirin Treatment

DESCRIPTION

Lipoprotein(a) (LPA) is a lipid-rich particle similar to low-density lipoprotein (LDL) and has been determined to be an independent risk factor for coronary artery disease. Individuals with a positive test for the LPA genetic variant rs3798220 have a higher risk for thrombosis and therefore may derive more benefit from the anti-thrombotic properties of aspirin. As a result, testing for the rs3798220 variant has been proposed as a method of stratifying benefit from aspirin treatment.

The LPA minor allele, rs3798220, is associated with higher levels of LPA and a higher risk for cardiovascular events. This allele is infrequent in the population and is associated with a modest increase in cardiovascular risk in the general population. Testing for this allele is commercially available, but performance characteristics are uncertain, and standardization of testing has not been demonstrated.

POLICY

IMPORTANT REMINDERS

ADDITIONAL INFORMATION

It cannot be determined from available evidence whether deviating from current guidelines on aspirin treatment based on LPA genetic testing improves outcomes. Therefore, measurement of the LPA rs3798220 variant as a decision aid for aspirin treatment is considered investigational.

SOURCES

American College of Cardiology, American Heart Association. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Retrieved October 11, 2017 from http://www.acc.org/guidelines#first=60&sort=%40foriginalz32xpostedz32xdate86069%20descending.

Anderson, J., Knight, S., May, H., Horne, B., Blair, T., Huntinghouse, J., et al. (2013). Validation and quantification of genetic determinants of lipoprotein-a levels and predictive value for angiographic coronary artery disease. American Journal of Cardiology, 112 (6), 799-804. Abstract retrieved October 11, 2017 from PubMed database.

BlueCross BlueShield Association. Medical Policy Reference Manual. (5:2015). Genetic testing for lipoprotein (a) variant(s) as a decision aid for aspirin treatment (2.04.70). Retrieved December 2, 2015 from BlueWeb. (20 articles and/or guidelines reviewed)

Kamstrup, P., TybiƦrg-Hansen, A., & Nordestgaard, B. (2013). Extreme lipoprotein(a) levels and improved cardiovascular risk prediction. Journal of American College of Cardiology, 61 (11), 1146-1156. Abstract retrieved October 10, 2017 from PubMed database.

Wang, Y., Wang, L., Liu, X., Zhang, Y., Yu, L., Zhang, F., et al. (2014). Genetic variants associated with myocardial infarction and the risk factors in Chinese population. PLoS One, 9 (1), doi:10.1371/journal.pone.0086332. (Level 3 evidence)

ORIGINAL EFFECTIVE DATE:  12/8/2012

MOST RECENT REVIEW DATE:  11/9/2017

ID_BA

Policies included in the Medical Policy Manual are not intended to certify coverage availability. They are medical determinations about a particular technology, service, drug, etc. While a policy or technology may be medically necessary, it could be excluded in a member's benefit plan. Please check with the appropriate claims department to determine if the service in question is a covered service under a particular benefit plan. Use of the Medical Policy Manual is not intended to replace independent medical judgment for treatment of individuals. The content on this Web site is not intended to be a substitute for professional medical advice in any way. Always seek the advice of your physician or other qualified health care provider if you have questions regarding a medical condition or treatment.

This document has been classified as public information.