Measurement of Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) in the Assessment of Cardiovascular Risk
DESCRIPTION
Lipoprotein-associated phospholipase A2 (Lp-PLA2), also known as platelet-activating factor acetylhydrolase, is an enzyme that hydrolyses phospholipids and is primarily associated with low density lipoproteins.
Accumulating evidence has suggested that Lp-PLA2 is a biomarker of coronary artery disease and may have a proinflammatory role in the progression of atherosclerosis. The recognition that atherosclerosis represents, in part, an inflammatory process has created considerable interest in measurement of proinflammatory factors as part of cardiovascular disease risk assessment.
POLICY
Measurement of lipoprotein-associated phospholipase A2 (Lp-PLA2) in the assessment of cardiovascular risk is considered investigational.
See also: Lipid Risk Factors in Risk Assessment and Management of Cardiovascular Disease
IMPORTANT REMINDER
We develop Medical Policies to provide guidance to Members and Providers. This Medical Policy relates only to the services or supplies described in it. The existence of a Medical Policy is not an authorization, certification, explanation of benefits or a contract for the service (or supply) that is referenced in the Medical Policy. For a determination of the benefits that a Member is entitled to receive under his or her health plan, the Member's health plan must be reviewed. If there is a conflict between the Medical Policy and a health plan, the express terms of the health plan will govern.
ADDITIONAL INFORMATION
Well designed studies in peer-reviewed journals are not available to demonstrate that health outcomes are improved as a result of measuring Lp-PLA2 in cardiovascular risk assessment.
SOURCES
BlueCross BlueShield Association. Medical Policy Reference Manual. (6.2010). Measurement of lipoprotein-associated phospholipase A2 (Lp-PLA2) in the assessment of cardiovascular risk (2.04.32). Retrieved July 2, 2010 from BlueWeb. (22 articles and/or guidelines reviewed)
Brown, T., & Bittner, V. (2008). Biomarkers of atherosclerosis: Clinical applications. Current Cardiology Report, 10 (6), 497-504.
Elkind, M., Tai, W., Coates, K., Paik, M., & Sacco, R. (2009). Lipoprotein-associated phospholipase A2 activity and risk of recurrent stroke. Cerebral Vascular Disease, 27(1), 42-50. (Level 4 Evidence – Industry sponsored)
Lp-PLA2 Studies Collaboration, Thompson, A., Gao, P., Orfei, L., Watson, S., Di Angelantonio, E., et al. (2010). Lipoprotein-associated phospholipase A2 and risk of coronary disease, stroke, and mortality: Collaborative analysis of 32 prospective studies. Lancet, 375 (9725):1536-1544. (Level 4 Evidence - Industry sponsored)
Madjid, M., Ali, M., & Willerson, J., (2010). Lipoprotein associated phospholipase A2 as a novel risk marker for cardiovascular disease. Texas Heart Institute Journal, 37 (1), 25-39. (Level 4 Evidence)
Nambi, V., Hoogeveen, L., Hu, Y., Bang, H., Coresh, J., Ni, H., et al. (2009). Lipoprotein-associated phospholipase A2 and high sensitivity C reactive protein improve the stratification of ischemic stroke risk in the atherosclerosis risk in communities study. Stroke, 40 (2), 376-381. (Level 3 Evidence - Industry sponsored)
U.S. Food and Drug Administration. (2007, December). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K072599. Retrieved July 2, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf7/K072599.pdf.
U.S. Food and Drug Administration. (2005, June). Center for Devices and Radiological Health. 510(k) Premarket Notification Database. K050523. Retrieved July 2, 2010 from http://www.accessdata.fda.gov/cdrh_docs/pdf5/K050523.pdf.
ORIGINAL EFFECTIVE DATE: 2/8/2009
MOST RECENT REVIEW DATE: 8/12/2010
ID_BA
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