BlueCross BlueShield of Tennessee Medical Policy Manual

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

Does Not Apply to Commercial Genetic Testing Program effective 6/1/2018

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. Testing for this allele is commercially available (e.g., CardioIQ® Aspirine Genotype test), 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 that measurement of the LPA rs3798220 variant improves outcomes.

SOURCES

American College of Cardiology, American Heart Association. (2013). 2013 ACC/AHA guideline on the assessment of cardiovascular risk. Retrieved August 23, 2019 from https://www.acc.org/guidelines.

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. Evidence Positioning System. (10:2018). Genetic testing for lipoprotein(a) variant(s) as a decision aid for aspirin treatment (2.04.70). Retrieved August 23, 2019 from https://www.evidencepositioningsystem.com/. (16 articlesand/or guidelines reviewed)

CMS.gov: Centers for Medicare & Medicaid Services. Palmetto GBA. (2018, February). Local Coverage Article: MolDX: LPA-aspirin genotpe coding and billing guidelines (A53467). Retrieved August 23, 2019 from https://www.cms.gov.

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. (2019). Use of lipoprotein(a) in clinical practice: a biomarker whose time has come. A scientific statement from the National Lipid Association. Retrieved August 23, 2019 from https://www.lipid.org/.

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:  10/10/2019    

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