The study was the first to analyze clinical and financial outcomes of adding a multimarker blood test to standard cholesterol testing. The new test checks a sample of the patient’s blood for three inflammatory biomarkers that may signal future heart attack and stroke risk. Each biomarker test costs $20 to $50.
Researchers from Cleveland HeartLab (CHL) and economists from Analysis Group calculated that if a commercially insured U.S. health plan with one million members adopted this approach, 2,018 heart attacks and 1,848 strokes could potentially be avoided, resulting in $180.6 million in cost savings over five years, compared to outcomes if standard screening methods were used.
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A More Accurate Way to Detect Heart Attack Risk
Improved strategies to detect hidden cardiovascular disease (CVD) are urgently needed, given that for 30 percent of people with CVD, the first symptom is death—often from a heart attack or stroke, says lead study author Marc Penn, MD, PhD, FACC, director of research at Summa Cardiovascular Institute and chief medical officer of CHL.
“Adding routine inflammatory testing to standard cholesterol takes prevention to the next level at very low cost, with a potentially enormous saving in both money and lives,” says Dr. Penn. This combined screening approach is known as multimarker testing.
Multimarker testing detects 37 to 43 percent more at-risk patients than would have been identified through checking levels of LDL (bad) cholesterol alone, a 2013 study by Dr. Penn and MDVIP, a physician group specializing is personalized medicine, found. The research, which included more than 95,000 patients, was published in Future Cardiology.
Are Your Arteries on Fire?
“Inflammation testing is like a fire alarm to warn of cardiovascular danger,” says Bradley Bale, MD, medical director of the heart health program for Grace Clinic in Lubbock, Texas and coauthor of Beat the Heart Attack Gene. “With these tests, we can find out if seemingly healthy patients are actually at high risk for heart attack or stroke.”
For example, adds Dr. Bale, “We have a patient who is in such superb physical condition that we’ve nicknamed him Superman. He only consulted us because his wife talked him into getting checked, but inflammatory testing revealed that his arteries were on fire—and ultrasound imaging found huge plaque deposits.”
These findings “were the cardiovascular equivalent of kryptonite in Superman’s arteries,” continues Dr. Bale, who routinely uses inflammatory testing in his medical practice.
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Warning Signs of an Impending Heart Attack
In a new paper, Dr. Bale reports that inflammatory testing—along with imaging—are key reasons why medical providers can actually guarantee arterial wellness.
The inflammatory tests used in the study check levels of these three biomarkers:
Myeloperoxidase (MPO). This immune system enzyme is normally only found at the site of an infection. Having elevated levels in the blood was the single strongest predictor of heart attack risk in the 2013 CHL/MDVIP study discussed above. “High MPO signals a high likelihood of vulnerable plaque [the most dangerous kind] in the arteries,” says Dr. Penn.
Lp-PLA2. This blood vessel enzyme, found to be the second most predictive of heart attack risk in the CHL/MDVIP study if elevated, also warns of vulnerable plaque that could erupt like a volcano, says Dr. Bale. “Lp-PLA2 has also been shown in a recent study to be a direct player in the atherosclerotic disease process.”
High-sensitivity C-reactive protein (hsCRP). This protein, produced in the liver, rises when there’s inflammation in the body. “In one large study, high levels of hsCRP were linked to triple the risk of heart attacks, compared to people with normal levels,” says Dr. Bale, who also points that a number of other conditions, including infections and inflammatory diseases.
50 Percent of Heart Attack Sufferers Have Normal Cholesterol
“Traditionally, doctors have focused on identifying and treating people with high cholesterol, but in 2014, this strategy is not sufficient because about 50 percent of people who have heart attacks or strokes have normal cholesterol levels,” reports Dr. Penn. “Inflammation testing can improve outcomes by identifying people with previously unsuspected risk.”
“Being able to tell which patients’ arteries are on fire—and prescribe appropriate treatments, which can include weight loss, more exercise, improved diets and medications—is key to saving lives, by taking early action to prevent heart attacks and strokes,” says Dr. Bale.
Currently, Medicare covers all three tests, but coverage varies among other plans.
“Every insurance plan should pay for these tests because arterial inflammation has been shown to actually cause cardiovascular disease—and ignite heart attacks. This study is exciting because it suggests that inexpensive tests can lead to huge cost savings,” adds Dr. Bale.
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