Inflammation Testing Prompts Care Changes Leading to Significantly Lower Levels in Patients with Increased Cardiovascular Risk Due to Diabetes or Pre-Diabetes

New research from MDVIP and Cleveland HeartLab LLC finds that patients with diabetes, pre-diabetes or no evidence of diabetes whose physicians ordered myeloperoxidase (MPO) inflammation testing achieved sharp reductions in MPO levels over five years. The investigators theorize the levels declined over time as a result of heightened awareness of cardiovascular risk provided by the MPO test results, and subsequent changes in patient behaviors or medication to attempt to lower that risk. The study was published in the Journal of International Medical Research.

Multiple studies have shown that elevated MPO blood levels signifies increased risk of myocardial infarction (heart attack) or stroke, independent of cholesterol blood levels, the conventional marker of cardiovascular risk. MPO inflammation testing is included in the MDVIP annual wellness program lab panel.

Investigators from MDVIP and Cleveland HeartLab, a business of Quest Diagnostics, performed the retrospective analysis based on de-identified MPO test results of approximately 285,000 patients under the care of MDVIP-affiliated physicians. Given the strong correlation between diabetes and cardiovascular disease, the investigators stratified patients into three populations - those with diabetes, pre-diabetes or no diabetes - based on blood levels of hemoglobin A1c, a diabetes marker.

Over a five-year period, the rate of MPO positivity decreased by 68.5 percent among patients with diabetes, 73.7 percent among patients with pre-diabetes and 72.2 percent among patients without diabetes. While patients with diabetes or pre-diabetes had higher MPO positivity rates than those without diabetes, decreases in vascular inflammation did not correspond with decreases in the prevalence of pre-diabetes or diabetes. MPO decreases were also observed in patients below or above guideline low-density lipoprotein (LDL) targets.

"Considering nearly half of all heart attacks now occur in patients with normal cholesterol, there is a clear need for the medical community to employ complementary diagnostic tools to gain a more complete view of a patient's cardiovascular risk," said co-author MDVIP Chief Medical Officer Andrea Klemes, D.O., F.A.C.E. "We know inflammation is linked to cardiovascular risk. Our research data demonstrates that physicians who monitor the inflammatory status of their patients are successful in helping patients lower their risk based on inflammatory biomarkers."

Lowering Inflammation Reduces Cardiovascular Events

While no drug therapy is currently approved to treat high inflammation levels for cardiovascular risk, physicians may consider a variety of measures to lower levels. MDVIP-affiliated physicians use MPO test results to develop a customized plan and recommendations that address a patient's lifestyle factors such as diet and exercise, as well as medications.

A trial recently published in the New England Journal of Medicine validated the concept that targeting inflammation in patients with a history of heart attack can lower their risk of cardiovascular events. The trial results showed that patients who received direct anti-inflammatory therapy were less likely to suffer a recurrent cardiovascular event compared to patients on placebo, independent of lipid-level lowering.i The study was significant because it showed, for the first time, that inflammation-targeted therapy reduces the risk of adverse cardiovascular events.

"The evidence is building that lowering inflammation is key to reducing cardiovascular risks, even when lipids are normal," said co-author Marc Penn, M.D., Ph.D., F.A.C.C., Chief Medical Officer of Cleveland HeartLab. "Our study with MDVIP shows that arming physicians and patients with insight into inflammation status may be enough to prompt actions that can help lower those risks over time."

The study's strengths include large sample size and ability to correlate diabetes status and MPO levels. The limitations include lack of clinical information from physicians on the strategies they implemented that led to decreases in MPO.

About MDVIP
MDVIP leads the market in membership-based healthcare that goes far beyond concierge medicine services. With a national network of nearly 900 primary care physicians serving more than 290,000 members, MDVIP is at the forefront of consumer-directed care. MDVIP-affiliated physicians limit the size of their practices, which affords them the time needed to provide patients with highly individualized service and attention, including a comprehensive annual preventive care program and customized wellness plan. Published research shows that the MDVIP model saves the healthcare system millions of dollars through lower hospitalizations and readmissions. 

About Cleveland HeartLab
Cleveland HeartLab Inc. (CHL) is the premier cardiovascular disease (CVD) Management Company with a comprehensive array of propriety tests focused on improving the early identification of those with CVD risk. In addition to its industry leading approach to inflammation testing, CHL manages a robust R&D program to accelerate the clinical use of scientifically proven and medically relevant biomarkers. Formed in 2009 as a spin-off from the Cleveland Clinic, CHL offers its testing to thousands of leading clinicians focused on health and wellness as well as corporate wellness plans through its CAP accredited and CLIA-certified clinical lab. With the goal of improving CVD risk assessment, CHL's unique testing provides a more complete picture of CVD risk allowing clinicians to deploy personalized medical programs and interventions to reduce the overall risk of CVD, with a specific focus on reducing the risks of inflammation.

Cleveland HeartLab is a business of Quest Diagnostics, the world's leading provider of diagnostic information services, and its clinical laboratory in Cleveland, Ohio, is Quest's center of excellence for cardiometabolic disorders. 

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