Some specialists say screening is needed to detect ‘bad cholesterol’ linked to heart attacks in younger people, but the RACGP is cautious...
Professor Mark Morgan, Chair of RACGP Expert Committee – Quality Care, believes there is a need for caution to ‘avoid confusion or implied recommendation’ for Lp(a) testing.
‘There is a big difference between population screening activities and the clinical work-up of selected patients who are particular high risk,’ he told newsGP.
Using examples of population screening including mammography and FOBT for bowel cancer, Professor Morgan cites the World Health Organization (WHO) version of Wilson and Jungner’s principles of screening, recommending that there should be a recognisable ‘latent or early symptomatic’ phase and ‘an accepted treatment’ for patients with recognised disease.
‘These principles effectively state that Lp(a) screening should only be considered if there is proven beneficial treatment available for screen-detected abnormal results,’ he said.
‘Much is still to be learnt about the biology of Lp(a) and the genetics that underpin the biology.
‘PCSK9 [Proprotein convertase subtilisin/kexin type 9] inhibitors have been shown to reduce Lp(a) levels, but it is not clear where they fit in primary prevention of patients’ first cardiovascular event.’
Prevention in primary care