Martin Haluzík: How LPA Variants May Guide Aspirin Therapy in Primary Prevention of Cardiovascular Disease
Martin Haluzík, Professor of Medicine at Institute for Clinical and Experimental Medicine, shared a post on LinkedIn about recent article by H. Robert Superko published in American Journal of Preventive Cardiology:
”The aspirin heart disease prevention conundrum
Very interesting paper with a huge relevance for our patients with diabetes published in American Journal of Preventive Cardiology by Robert Superko, and colleagues.
- The use of daily aspirin in a primary prevention population to reduce cardiovascular disease event risk is a conundrum because the reduction in cardiovascular event risk is balanced by an equal increase in the risk of a serious gastrointestinal bleed.
- This conundrum can be partially clarified by genetic testing for LPA polymorphisms. A genetic polymorphism in the apolipoprotein (a) component of lipoprotein (a) has been identified that could help identify patients who may benefit the most from daily aspirin in regard to coronary heart disease event reduction.
- Recent clinical trials have demonstrated that carriers of the LPA variant (rs3798220) have a significantly greater risk for a coronary heart disease event compared to non-carriers.
- However, in carriers of the LPA variant randomized to aspirin, the incidence of major coronary heart disease events was reduced to the same level as subjects who did not have the LPA variant.
- This provides a clinically available tool that may allow identification of a subset of primary prevention patients who derive more cardiovascular risk reduction from daily aspirin than the risk of a serious gastrointestinal bleed. This provides an inexpensive treatment options for patients with the LPA variant.
Very interesting paper
It nicely summarizes how genetic testing in this case of LPA variant can provide more information regarding efficacy of aspirin in the prevention of major coronary heart disease events in primary prevention patients
This is an excellent example of personalized medicine.
The major rrawback that can be hopefully resolved in the near future is the availability of this genetic testing
Title: The aspirin heart disease prevention conundrum
Authors: H. Robert Superko, John Sninsky, Brenda Garrett
Read the Full Article on American Journal of Preventive Cardiology
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