Advanced Testing for Cardiovascular Disease Joseph P. McConnell, - - PowerPoint PPT Presentation

Advanced Testing for Cardiovascular Disease

Joseph P. McConnell, Ph.D., DABCC Joseph P. McConnell, Ph.D., DABCC Laboratory Director and Chief Medical Officer Laboratory Director and Chief Medical Officer

Health Diagnostic Laboratory Health Diagnostic Laboratory National Lipid Association Meeting New York, NY New York, NY

May 20, 2011 May 20, 2011

Health Diagnostic Laboratory Inc. (HDL Inc.) History

Health Diagnostic Laboratory, Inc. (HDL) was founded in 2008. Capital acquired in July of 2009 November 2009: Accreditation from the College of American Pathologists (CAP) and Clinical Laboratory Improvement Amendments (CLIA) The Founders collectively have over 70 years of experience in the field of Laboratory Medicine holding key positions in renowned and respected medical, educational, and industrial institutions including: The Mayo Clinic University of Washington, Northwest Lipid Research Center Indiana University Medical Center Berkeley Heart Laboratory Wako Diagnostics

Our Founders

The HDL Mission

To identify through laboratory testing

why cardiovascular disease is occurring in each individual, and tailor therapy to halt

• r reverse disease progression, extending

the quality and length of life.

Live healthy until you die! ☺

The HDL Business Approach

The goal is prevention. HDL is solutions focused and not technology driven bent on outcomes Through strategic partnerships with industry, researchers, and physician/medical educators, we use a team approach to understanding where an individual is on the disease continuum and tailor therapies to achieve a diagnosis of health.

Advanced CVD Risk Testing

The cost of laboratory tests make up about 3-5%

• f total health care costs, but are responsible for

about 75-85% of medical treatment decisions. By performing low cost advanced testing, we can decrease the large downstream costs of catastrophic events like MI, stroke, DVT and PE, and interventions (CABG, etc.) saving $$$ in medical care cost.

Physicians customize testing panels Physicians customize testing panels

Physicians customize testing panels Physicians customize testing panels

Case Studies

Case #1: 45 yr Male: Family History

Maternal Grandfather died at age 57, two years after his first stroke (significant morbidity). Maternal Grandmother died at age 61 of MI, apparently in her sleep. Paternal Grandfather died at age 63, massive coronary. Paternal grandmother died of a stroke at age 62. Father survived first MI at age 61, died following 2nd MI at age 62.

A healthy 38 years old female is interested in a cardiovascular evaluation because her seemingly healthy father in his early 60s just had a myocardial infarction followed by triple vessel coronary bypass surgery. She appears quite healthy with a BMI of 24 (5 6 inches and 150 lbs) and is normotensive. There is no history of

• smoking. She has two children ages 3 and 5 and there was no

gestational diabetes.

Case #2: A Concerned Young Woman

Case #2: A Concerned Young Woman

Case#3: 50 year old Male

124

Different Inflammatory Markers: Different Roles

Adapted from: Rader D. N Engl J Med. 2000

Additive Risk for Incident CHD for LDL <130 by Lp-PLA2 and hsCRP Tertiles

Adjusted for demographics, current smoking status, blood pressure, diabetes, and HDL Ballantyne et al., Circulation 2004

1 2 3 4 5 hsCRP top hsCRP bottom Lp-PLA2 bottom Lp-PLA2 top

4.2 1.2 1.4 1.0 Risk Ratios

(95% CI 1.7-10.3, p=0.001)

Case #4: 36 year old Female

Father: MI at age 45

Significant hyperlipidemia resistant to therapy Has had numerous stents placed over the years.

Patient presents with known hyperlipidemia

Current Meds: Rosuvastatin (Crestor 20)

Previously on crestor 40 but complained of myalgias

Concerned about hyperlipidemia Therapeutic lifestyle changes

Case #4: 36 year old Female

Interpretive comment:

The elevated LDL cholesterol is consistent with heterozygosity for familial hypercholesterolemia. Family studies are recommended.

Familial Hypercholesterolemia

Most common genetically inherited disorder that we can treat in the US Frequency estimated 1:500 in the US

NLA Launching Campaign on Awareness of Familial Hypercholesterolemia (FH)

Recommended LDL cholesterol cut points for identification of individuals likely to have FH. < 20 years old: LDL-C > 160 mg/dL 20-29 years old: LDL-C > 190 mg/dL > 29 years old: LDL-C > 200 mg/dL FH: Its RelativeKnow Your Family Cholesterol History Ask your relatives to be screened as well

Elevated LDL Cholesterol in ca. 200,000 HDL

• Inc. Patients

< 20 years old with LDL-C > 160 mg/dL

2.26%, total N = 886; or 20 possible FH

20-29 years old with LDL-C > 190 mg/dL

0.87%, total N = 5493; or 48 possible FH

> 29 years old: LDL-C > 200 mg/dL or > 220 mg/dL

LDL-C > 200: 0.87%, total N = 194483; 1692 possible FH LDL-C >220: 0.32%, total N = 194483; 622 possible FH

NLA Launching Campaign on Awareness of Familial Hypercholesterolemia (FH)

We congratulate the NLA on this needed effort! We are willing to help participate in identification of FH patients. Also planning to help with such efforts as patient registries and generation of family trees, etc.

Case #5: A 26 Year old female

Factor V Leiden and Prothrombin G20210A Mutations

Associated with Venous Thromboembolism DVT = Deep Venous Thrombosis PE = Pulmonary Embolism

Factor V Leiden and Prothrombin G20210A Testing Heterozygous carriers of factor V Leiden have approximately 5 fold increased risk for DVT/VTE Homozygous carriers have as much 80 to 100 fold increased risk. Compound heterozygotes of Factor V and Prothrombin mutations have significantly increased risk for DVT/VTE (50 100 fold).

Estimated Prevalence of VTE in the USA

As many as 450,000 cases of DVT annually

• Approx. 250,000 cases PE

40-45% fatal

Deep Venous Thrombosis

Clots Surgically Removed

14 y-o female in for cervix biopsy. PE at the bifurcation

• f the pulmonary artery 2 days later. (Biopsy was benign).

Good News

Most DVTs are avoidable

Maintain good circulation Anti-coagulate during surgical procedures Consider alternative birth control to oral contraceptives Control homocysteine elevations (30X risk) Watch fibrinogen levels

Current Recommendations for Use

After a patient has had a VTE (DVT, PE, etc) Test to see if person is predisposed If positive test family members Not recommended for screening purposes Why not?

Reflex to Warfarin Sensitivity Testing?

If patient is predisposed to VTE, reflex to warfarin sensitivity testing: CYP2Cp and VKORC1 testing Determine proper warfarin loading and maintenance doses.

Patient Medical Information Card

Advanced CVD Risk Testing

The cost of laboratory tests make up about 3-5%

• f total health care costs, but are responsible for

about 75-85% of medical treatment decisions. By performing low cost advanced testing, we can eliminate the large downstream costs of catastrophic events like MI, stroke, DVT and PE, saving $$$ in medical care cost.

Advanced CVD Risk Testing

Laboratory testing can make a difference! Almost everyone has disease, but our individual diseases may have a different root causes. Lab testing can find the root cause of disease. By addressing the root cause, we can halt or reverse disease, leading to a diagnosis of health.

Health Diagnostic Laboratory, Inc. Advanced Testing for Cardiovascular Disease

Cardiovascular disease is preventable and progression can be halted or even reversed. Together.through teamworkwith education, research and a united message We can beat CVD!!!

Thank You! Thank You!

Please join us at the HDL, Inc. booth Please join us at the HDL, Inc. booth (numbers 10 and 12) tomorrow, Saturday (numbers 10 and 12) tomorrow, Saturday May 21 May 21st

st, for a

, for a book signing book signing featuring Dr. featuring Dr. Thomas Dayspring, Dr. Michael Richman, Thomas Dayspring, Dr. Michael Richman, and Russ Warnick, Chief Scientific Officer and Russ Warnick, Chief Scientific Officer at HDL, Inc. at HDL, Inc.