Does Not Apply to Commercial Genetic Testing Program effective 6/1/2018
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.
Genetic testing for lipoprotein (a) variant(s) (i.e. LPA rs3798220 allele) as a decision aid for aspirin treatment is considered investigational.
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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.
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. (10:2017). Genetic testing for lipoprotein (a) variant(s) as a decision aid for aspirin treatment (2.04.70). Retrieved August 28, 2018 from BlueWeb. (20 articles and/or guidelines reviewed)
Kamstrup, P., Tybiærg-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.
National Lipid Association. (2011) Clinical utility of inflammatory markers and advanced lipoprotein testing: advice from an expert panel of lipid specialists. Journal of Clinical Lipidology, (5), 338-367.
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)
MOST RECENT REVIEW DATE: 11/8/2018
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