A just-published report, co-authored by the medical leadership of Cleveland HeartLab (CHL) and MDVIP for the peer-reviewed journal Future Cardiology (July 2013), clearly demonstrates the utility of a multimarker approach to determine cardiovascular risk.
The data that was reviewed came from over 95,000 MDVIP patients who received an annual wellness panel that contains multiple biomarkers that go beyond basic lipid tests. As part of a comprehensive approach to wellness and prevention, MDVIP-affiliated physicians use this advanced testing to drive early detection and highly personalized care.
The new report analyzing one of the largest patient screening data sets validates a significant difference between a multimarker approach, including CHL’s inflammation testing, versus conventional lipid-only testing. The MDVIP biomarker wellness panel proved to be a highly effective tool in risk prediction. This distinction is vitally important due to the fact that at least 50% of patients who present with acute myocardial infarction (heart attack) have “normal” or treated cholesterol levels.
“The report is significant validation for CHL’s multimarker approach to identify arterial inflammation that has been shown to be predictive of risk for future heart attack and stroke, even in seemingly healthy patients,” said Marc Penn, MD, PhD, FACC, Chief Medical Officer of CHL and Director of Cardiovascular Research, Summa Health System, Akron, OH. “We have a strong commitment to detect and diminish cardiovascular risk and further long-term health and well-being through the development of novel tests to define cardiovascular risk.”
Significant data presented in the report:
Based on a lipid-only wellness panel, approximately 30% of patients presented as being at risk.
Based on a multimarker panel, 70% of patients were found to be at risk, with 40% having more than one marker positive.
“Not only are we identifying more patients at risk in our preventive care model, but we are more specifically determining where those patients are on the spectrum of risk, which has a great impact on clinical care,” added Andrea Klemes, DO, Medical Director of MDVIP, the premier network of affiliated primary care physicians practicing wellness and prevention. “Our physicians are confident that with this approach they are preventing the onset of cardiovascular disease and helping to keep inflammation at bay.”
Additionally, the report went on to compare findings reflected in data on higher acuity markers: Lp-PLA2 and MPO. Independent studies have demonstrated that each of these biomarkers indicates the presence of increased risk for cardiovascular events based on increased risk for plaque vulnerability.
In the additional set, results of Lp-PLA2 and MPO testing of 2,700 patients from executive health and preventive cardiology clinics highlighted the importance of a multimarker strategy to identify risk. The biomarkers analyzed in the report show that approximately 6% of the patients had increased risk (due to an elevated MPO), while 5% of the patients were at risk (due to an elevated Lp-PLA2). However, in this asymptomatic outpatient population only 0.2% showed elevated levels for both markers.
“As we note in the paper, independent of whether these inflammatory pathways are involved in disease progression, by understanding the physiology these markers reflect when elevated, we can garner a deeper understanding of individual patient risk for cardiovascular events and treatment effects through a multimarker approach without redundancy in the case of MPO and Lp-PLA2,” said Dr. Penn. “If one were to take a single marker approach, it would suggest that one is comfortable with assessing only one side of the coin or only half of the patient’s potential for risk,” stated Dr. Penn.
The multimarker screening panel for the report in the Future Cardiology article, “Multimarker Approach for Identifying and Documenting Mitigation of Cardiovascular Risk,” was developed in leadership collaboration between MDVIP and CHL for 95,144 patients who underwent wellness panel screenings performed by their MDVIP physicians in 2011. All analyses were performed on de-identified data, without regard for past medical history, physical examination or medication profile. Analysis was completed at the Cleveland HeartLab, Cleveland, OH.