Predicting Heart Disease Up to 15 Years After Initial Blood Testing

Measuring lipoprotein a (Lp(a)) levels in the bloodstream may indicate a patient’s risk of developing heart disease over the next 15 years, according to research published in The Journal of the American College of Cardiology.

In 1995, researchers from Innsbruck Medical University in Austria measured the Lp(a) of 826 men and women aged 45 to 84 years and recorded the incidence of cardiovascular disease (CVD) for the following decade and a half in order to determine if Lp(a) improves CVD risk prediction. The researchers hypothesized that Lp(a) was a causal risk factor for CVD, though, at the time, clinical risk assessments had not been established for Lp(a) involvement.

Overall, by adding an additional baseline Lp(a) evaluation improved the ability of researchers to classify about 40 percent of the study participants into higher- or lower risk groups. This was true all the way to the 15 year follow up end point.

Of the 502 participants who remained free of CVD, 82 patients were correctly reclassified to a lower risk category. An additional 49 patients were reclassified into a higher risk category. There were 148 patients who developed CVD; of those, 18 were reclassified into a higher risk grouping and 17 were downgraded to a lower risk group.

Lp(a) levels may change 10 to 20 percent over a lifetime, noted commentator Stanley Hazen, MD, PhD, from the Cleveland Clinic who was not involved in the study. One measurement of Lp(a) allows health care providers the opportunity to zero in on patients who need the most preventative care, including those with first degree relatives with a history of CVD.

“Getting just a single measure of Lp(a) can help to identify those for whom more aggressive preventive efforts may yield the most benefit for a lifetime,” said Hazen. “Lp(a) testing should become part of our standard initial risk assessment early in adulthood — when preventive efforts for those most in need will have the largest benefit. You can reduce your cardiovascular risks by lowering your cholesterol, monitoring blood pressure, and insuring that your blood sugars are well controlled.

In the future, medications to lower Lp(a) could hold off CVD development in patients who have not developed it yet, researchers speculate.