FDA approves blood test that predicts risk of coronary heart disease

 

The PLAC Test for Lp-PLA2 screens for cardiovascular inflammation which can lead to a build up of rupture-prone plaque and result in a heart attack or stroke (Photo: Shutterstock) Coronary heart disease (CHD) kills millions of people across the world each year, and more than half of those who die suddenly have no previous symptoms. A new blood test that could reduce CHD-related illness and mortality by predicting the risk of future heart disease has been cleared by the US Food and Drug Administration (FDA). The PLAC Test for Lp-PLA2 screens for cardiovascular inflammation which can lead to a build up of rupture-prone plaque and result in a heart attack or stroke. The PLAC Test for Lp-PLA2 is designed for people with two or more risk factors for cardiovascular disease who may have hidden risk or higher risk than expected for heart attack and stroke. Although it has been approved for use in all adults with no history of heart disease, studies submitted by diaDexus, the medical diagnostics company that developed the test, and reviewed by the FDA, show that the test is better at predicting risk in women, particularly black women. "A cardiac test that helps better predict future CHD risk in women, and especially black women, may help health care professionals identify these patients before they experience a serious CHD event, like a heart attack," says Alberto Gutierrez, director of the Office of In Vitro Diagnostics and Radiological Health in the FDA’s Center for Devices and Radiological Health. According to diaDexus, 50 percent of heart attacks occur in patients with normal cholesterol. Statistics cited by the company suggest the majority of heart attacks and ischemic strokes are caused by plaque rupture in the arteries, which can occur when vascular inflammation is present. The PLAC test measures a patient’s blood for levels of Lp-PLA2, a biological marker for vascular inflammation that plays a significant role in the formation of rupture-prone plaque. If inflammation is present, it can cause the cap covering the plaque to thin and eventually rupture. When this happens, the flow of blood to the heart or brain can become blocked and lead to a heart attack or a stroke. Patients with test results that show Lp-PLA2 activity greater than the level of 225 nanomoles per minute per milliliter (nmol/min/mL) are at increased risk for a CHD event, even if they have normal cholesterol (LDL) levels. Knowing a patient's Lp-PLA2 level can help healthcare professionals identify whether the person is at risk for rupture-prone plaque. If so, they can use the results to help motivate the patient to adopt lifestyle changes, or recommend treatment options where necessary. Sources: U.S. Food and Drug Administration, diaDexus

Mentally stressed young women with heart disease more likely to have reduced blood flow to heart

 

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Young women with stable coronary heart disease are more likely than men to have reduced blood flow to the heart if they're under emotional stress, but not physical stress, according to research presented at the American Heart Association's Scientific Sessions 2014.

Compared to men of the same age, when subjected to a mental stress test, women:

• age 55 and younger had three times greater reduction in blood flow to the heart;
• age 56-64 had double the reduction in blood flow to the heart; and
• age 65 and older had no difference in blood flow to the heart.

"Women who develop heart disease at a younger age make up a special high-risk group because they are disproportionally vulnerable to emotional stress," said Viola Vaccarino, M.D., Ph.D., study author and chairwoman of Cardiovascular Research and Epidemiology at Emory University's Rollins School of Public Health in Atlanta, Georgia.

Women generally develop heart disease later in life than men. However, younger women who have premature heart attacks are more likely to die than men of similar age. Risk factors, such as diabetes or high blood pressure, don't explain these mortality differences.

In the study, researchers gave a standardized mental stress test and, on a separate day, a traditional physical stress test (exercise treadmill test or pharmacological stress test) to 534 patients with stable coronary heart disease. For the mental stress protocol, patients were asked to imagine a stressful life situation and deliver a speech about this story in front of a small audience.

Researchers used nuclear imaging to take pictures of the heart while undergoing each of the two stress tests and while at rest. They also monitored heart rate and blood pressure during both mental and physical tests. Then, they analyzed the differences in coronary blood flow based on gender and age. In contrast to the large differences in blood flow observed with mental stress, there were no differences in blood flow with physical stress between women and men.

Young and middle-age women may be more vulnerable to emotional stress because they face considerable burden of stressors in everyday life such as managing kids, marriage, jobs and caring for parents, Vaccarino said. Biology may also play a role -- for example, a greater propensity towards abnormal blood vessel function during emotional stress, such as exaggerated constriction of coronary or peripheral blood vessels.

Healthcare providers should be aware of young and middle-age women's special vulnerability to stress and "ask the questions about psychological stress that often don't get asked," Vaccarino said.

"If they note that their patient is under psychological stress or is depressed, they should advise the woman to get relevant help or support from mental health providers, stress reduction programs or other means."

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Story Source:

The above story is based on materials provided by American Heart Association. Note: Materials may be edited for content and length.

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Cardiology leaders call for global prevention of heart disease, stroke

 

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Heart disease and stroke contribute to 30 percent of global deaths, more than all infectious and parasitic diseases combined, and 11 cardiovascular organizations are calling for the United Nations to address prevention of heart disease and other non-communicable diseases.

In a statement published in the Journal of the American College of Cardiology and other cardiology journals, the World Heart Federation's Global Cardiovascular Disease Taskforce -- which is comprised of cardiologists and health advocates from the World Heart Federation, African Heart Network, Asia Pacific Heart Network, Asian Pacific Society of Cardiology, American Heart Association, American College of Cardiology, European Heart Network, European Society of Cardiology, InterAmerican Heart Foundation, InterAmerican Society of Cardiology, and the Pan-African Society of Cardiology -- calls for the United Nations to support efforts to curb the world-wide rise in non-communicable diseases including heart disease and stroke.

"We must cooperate and collaborate across sectors and disciplines to advance and affirm a positive return of investment in cardiovascular health; only then will we influence countries and businesses to devote crucial resources to our collective goal, which is vital to human health and wellbeing across the world," the task force said in the statement Sustainable Development Goals and the Future of Cardiovascular Health.

Globally, it is estimated that from 2011-2025, the economic burden of non-communicable diseases will be $7 trillion, with cardiovascular disease accounting for most of that expense.

"Prevention of cardiovascular disease through support of healthy diets and physical activity along with blood pressure control and anti-smoking efforts should be part of -- if not at the center of -- the U.N.'s health goals in 2015 and beyond since these factors are so closely tied to many health issues," said ACC past-President William A. Zoghbi, MD, MACC, a co-chair of the task force.

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Story Source:

The above story is based on materials provided by American College of Cardiology. Note: Materials may be edited for content and length.

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Journal Reference:

1. William A. Zoghbi, Tony Duncan, Elliott Antman, Marcia Barbosa, Beatriz Champagne, Deborah Chen, Habib Gamra, John G. Harold, Staffan Josephson, Michel Komajda, Susanne Logstrup, Bongani M. Mayosi, Jeremiah Mwangi, Johanna Ralston, Ralph L. Sacco, K.H. Sim, Sidney C. Smith, Panos E. Vardas, David A. Wood. Sustainable Development Goals and the Future of Cardiovascular Health. Journal of the American College of Cardiology, 2014; 64 (13): 1385 DOI: 10.1016/j.jacc.2014.08.018

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