Q&A: Lipid profiling test may enable 'personalized, preventive medicine'

A lipid profiling blood test may predict the risk for type 2 diabetes and CVD years in advance, according to findings published in PLOS Biology.

“The lipidomic risk, which is derived from only one single mass spectrometric measurement that is cheap and fast, is informative and could extend traditional risk assessment based on clinical assays,” Chris Lauber, PhD, an assistant professor in the Institute of Experimental Virology at the TWINCORE Center for Experimental and Clinical Infectious Research in Germany, and colleagues wrote.

The researchers used lipidomics, which measure different types of fat present in blood, to assess future type 2 diabetes and CVD risk in 4,067 patients in Sweden. The participants were recruited to the large prospective population-based cohort study between 1991 and 1994. After undergoing medical and physical exams and baseline lab assessments, the participants provided fasting blood samples for lipidomics analyses. Lauber and colleagues followed the participants until 2015.

Among 3,688 participants who qualified for a diabetes analysis, 13.8% developed type 2 diabetes during the follow-up period. The researchers also reported that among 3,951 participants who qualified for a cardiovascular analysis, 22% had coronary artery disease, a stroke event or died from a cardiovascular event during follow-up.

Based on the incidence of CVD and type 2 diabetes during a 23-year follow-up, the researchers used 184 plasma lipid concentrations measured at baseline to establish a lipidomic incidence risk score for type 2 diabetes and CVD. These rates were compared with average case rates of 13.8% for type 2 diabetes and 22% for CVD.

Lauber and colleagues reported a 168% and 84% increase in incidence for type 2 diabetes and CVD, respectively, in the highest-scoring group of participants. Among participants with the lowest scores, the researchers reported a decrease of 77% and 53% in incidence for type 2 diabetes and CVD.

“Our results demonstrated that a subset of individuals at high risk for developing type 2 diabetes or CVD can be identified years before disease incidence,” Lauber and colleagues wrote.

Healio spoke with Lauber to learn more about the future of lipidomics in clinical practice.

Healio: How strong is the evidence linking certain lipids to conditions like diabetes or CVD?

Lauber: We are providing solid evidence for a linkage between levels of individual lipid and conditions like diabetes or CVD. The findings of [our study] are in line with and extend to current clinical chemistry because they provide a high-resolution image of molecular lipid metabolism.

Healio: How do you see this kind of blood test being utilized by physicians? How feasible is it to conduct this kind of testing?

Lauber: Once a clinical lipidomics test is established, physicians would draw blood samples from their patients on a regular basis and send the samples to a lipidomics analysis facility. After the analysis, the physician would receive a report with details about the patient. This process is comparable to the current blood panel, a staple of current medical practice, and we expect it to be as feasible likewise.

Healio: Which patients should undergo this testing?

Lauber: We envision a future clinical lipidomics test serving very early preventive measures. Thus, ideally, every person should be tested on a regular basis. At minimum, such a clinical lipidomics test would be available to patients with existing preconditions such as obesity, family history or lifestyle habits linked to CVD and type 2 diabetes.

Healio: What can physicians recommend to patients who have a high likelihood of developing CVD or diabetes later in life based on lipid profiling?

Lauber: Physicians may continue to recommend the same measures they are currently recommending to high-risk patients, such as increased physical activity and dietary changes. We believe a future clinical lipidomics test facilitates physicians to intervene much earlier and thus potentially increasing the likelihood of preventing disease onset. Further, physicians may be enabled to monitor the impact of their recommendations on a molecular scale and thus may adapt their preventive measures therapy on an individual basis — in short, personalized, preventive medicine.

Healio: Do you worry that lipid profiling may inflict stress on patients who are predicted to have a high likelihood of CVD or diabetes?

Lauber: Potentially, such information may inflict stress on patients. Yet, this does not change the outcome of the test and their individual likelihood of developing CVD or type 2 diabetes. Further, a future clinical lipidomics test may also facilitate patients to monitor their prevention success and experience their progress towards a better life through an objective clinical assay. We believe the benefits of quantifying risk for future CVD and type 2 diabetes and quantifying prevention success may outweigh the stress potential for an individuum.

Healio: How can lipidomics be used to develop new treatments?

Lauber: Lipids are a fundamental part of every living organism. They are building blocks of life impacting a myriad of biological processes. Lipidomics is the identification and quantification of the thousands of different lipids within a biological sample, the full lipidome. Thus, lipidomics is used to develop new therapies, medications and, like in this study, find new biomarkers. The lipidomics approach is not limited to CVD and type 2 diabetes. For example, neurodegenerative diseases are often accompanied by profound lipidome changes, and it has been shown that lipid metabolism changes are a hallmark of cancer in general.

Healio: Anything else to add?

Lauber: This is a first step in the direction of personalized preventive medicine, and we will now progress to take the next steps.

Reference:

Lauber C, et al. PLOS Biol. 2022;doi:10.1371/journal.pbio.3001561.