May 2003

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New test predicts heart disease in low-risk patients

By John Tyler

Christie Ballantyne, MD

A new blood test can help physicians predict coronary disease and even heart attack risk in patients not previously considered at risk, according to data presented by a Baylor College of Medicine professor at the American College of Cardiology’s 52nd Annual Scientific Session in Chicago in April.

Dr. Christie Ballantyne, director of the Center for Cardiovascular Disease Prevention at Baylor College of Medicine and the Methodist DeBakey Heart Center in Houston, reported both lipoprotein-associated phospholipase A2 (Lp-PLA2) and C-reactive protein (CRP) are independently associated with the incidence of coronary heart disease.

“Unfortunately, many people with ‘normal’ LDL cholesterol (or bad cholesterol) are not targeted for preventive therapies because they are not considered at risk for heart disease,” said Ballantyne. “However, we found that even if patients have normal LDL levels, they are at increased risk for heart disease if they have high levels of either CRP or Lp-PLA2.”

In fact, from one-third to one-half of all coronary events such as heart attacks occur in patients with low LDL (less than 130 milligram per deciliter) and no evidence of other risk factors. These include low HDL cholesterol, a family history of premature heart disease, high blood pressure, smoking and diabetes.

“Based on these findings, this study is a valuable step in developing preventive strategies that may utilize blood tests for Lp-PLA2 and CRP to identify high-risk patients,” he said. Lp-PLA2 is an enzyme commonly found in human blood plasma and arterial plaques.

“The PLAC test a simple and straightforward blood test that can be easily performed in most clinical and pathology laboratories to precisely measure the level of Lp-PLA2 in an individual’s blood,” Ballantyne said.

There is a vast body of research indicating that the inflammatory process (the body’s reaction to infection) plays a major role in the development of atherosclerosis, said Ballantyne. The association between inflammation, the infection it fights and coronary heart disease is not completely understood. The focus of his current research is Lp-PLA2, which has been shown to be a novel biomarker for coronary heart disease and plays an important role in the inflammatory process.

That role suggests that certain forms of atherosclerosis could potentially be prevented, and treated, by inhibiting the activity of Lp-PLA2. Clinical trials, using the PLAC test to measure levels of Lp-PLA2, are currently underway to explore therapies that specifically inhibit the activity of the enzyme.

Other inflammatory markers that may predict coronary heart disease include C-reactive protein, fibrinogen and soluble adhesion molecules.

“The incidence of coronary heart disease, and the seriousness of coronary events, warrants new research into identifying new markers of the disease beyond traditional risk factors,” said Ballantyne. “We believe that measuring levels of Lp-PLA2 may offer physicians an important new tool in better evaluating, and potentially treating, their patients.”

Coronary heart disease ranks as the leading cause of death in the United States, affecting more than 12.9 million Americans. According to the American Heart Association, nearly half of all patients that experience coronary events, such as heart attacks, do not exhibit traditional risk factors such as smoking, obesity, high blood pressure or elevated LDL cholesterol.

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