Change in lipoprotein-associated phospholipase A2 and its association with cardiovascular outcomes in patients with acute coronary syndrome

Abstract

Lipoprotein-associated phospholipase A2 (Lp-PLA2) probably plays an important role in the development of acute coronary syndrome (ACS). However, alterations of Lp-PLA2 levels during ACS and its association with cardiovascular outcome are unclear. Our aim was to investigate the change in Lp-PLA2 and its association with cardiovascular outcome in patients with ACS.A total of 79 patients with ACS came from the coronary care unit (CCU) between June 1, 2015 and August 31, 2016 in this longitudinal study. Serum levels of Lp-PLA2, troponin I, and creatine kinase isoenzymes MB (CK-MB) were measured at admission, on the first morning (D1), on the second morning of hospitalization (D2), and on the last second morning before discharge (D4). The patients were followed up till November 30, 2016. The primary outcomes were cardiovascular death and cardiovascular rehospitalization. Kaplan–Meier analysis and Cox proportional hazard models were used to identify risk factors for poor outcome in patients with ACS.All patients were followed up for 10.6 ± 4.7 months. The patients were divided into 2 groups according to the median of Lp-PLA2: lower Lp-PLA2 group and higher Lp-PLA2 group. Elevated levels of Lp-PLA2 significantly decreased during the early phases of ACS in higher Lp-PLA2 group. And Lp-PLA2 level increased at first and then decreased in lower Lp-PLA2 group. Kaplan–Meier analysis showed that patients with elevated Lp-PLA2 had a lower cardiovascular event-free survival (log-rank χ2 = 4.736, P = .030) than those with lower Lp-PLA2. Cox regression analysis indicated that high Lp-PLA2 level (hazard ratio [HR] = 1.005, 95% confidence interval [CI] = 1.002–1.008, P = .003), time delay from symptom onset to admission (HR = 1.088, 95% CI = 1.038–1.139, P < .001) independently predicted cardiovascular event in patients with ACS after adjusting for potential confounders.Serum level of Lp-PLA2 altered considerably during the early phase of ACS and increased Lp-PLA2 independently predicted cardiovascular outcome in patients with ACS after adjustment for potential confounders.

Relationship between atherosclerosis risks and lipoprotein-dependent phospholipase a2 activity in type 2 diabetic patients

“…Persson et al [24] observed that this enzyme was strongly correlated with lipid fractions and the degree of carotid artery atherosclerosis; this study showed that the association with cardiovascular risk is stronger for activity than for mass, reinforcing the impact of activity in atherogenesis [24]. Lp-PLA 2 , known as a novel inflammatory biomarker, is involved in the pathophysiology of atherosclerosis [5]. Lp-PLA 2 plays a role as a novel predictor of cardiovascular risk in a population at high risk for future CVD events [25][26][27][28][29].…”

“…Lipoprotein-associated phospholipase A2 (Lp-PLA 2 ), known as a novel inflammatory biomarker, is involved in the pathophysiology of atherosclerosis [5]. Lp-PLA 2 is produced by monocyte, macrophage and T lymphocytes on the atherosclerotic process [6][7][8].…”

Research Progress on the Relationship between Lipoprotein Associated Phospholipase A2 and Coronary Atherosclerotic Heart Disease

“…These data highly suggest that the serum level of Lp-PLA2 in ACS patients has a certain clinical predictive value for the occurrence of MACEs within 6 months after discharge [23]. In Li et al study, Kaplan-Meier analysis showed that patients with elevated Lp-PLA2 had a lower cardiovascular event-free survival than those with lower Lp-PLA2.Meanwhile, Cox regression analysis of this study indicated that high Lp-PLA2 level, time delay from symptom onset to admission independently predicted cardiovascular event in patients with ACS after adjusting for potential confounders [24]. Maiolino et al reported that The survival without recurrent myocardial infarction rate was 81.2% in ACS patients with higher serum Lp-PLA2, which was significantly lower than that in ACS patients with lower serum Lp-PLA2.…”

Modelling of longitudinal data to predict cardiovascular disease risk: a methodological review

“…The simplest method of utilizing the Cox PH model was used by including the values of the longitudinal outcome at baseline (Time 0) (n = 7, 17.5%) [ 18 , 21 , 24 , 43 , 50 , 53 , 54 ]. For example, Tanne et al used baseline values of SBP to predict ischemic stroke mortality [ 53 ].…”