High Lipoprotein-Associated Phospholipase A2 Is a Risk Factor for Recurrent Coronary Events in Postinfarction Patients

Abstract

Background: Recent studies demonstrate that lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) is a risk factor for cardiovascular disease presumably deriving from generation of proinflammatory and proatherogenic species through its hydrolytic activity on lipoprotein-associated phospholipids. The goal of this study was to assess the relationship of Lp-PLA 2 with a set of thrombogenic, lipid, inflammatory, and metabolic blood markers and to determine whether plasma Lp-PLA 2 is a risk factor for recurrent coronary events in postinfarction patients. Methods: Factor analysis on the set of blood markers and Lp-PLA 2 was performed for 766 patients of the Thrombogenic Factors and Recurrent Coronary Events (THROMBO) postinfarction study. Recurrent coronary event risk was assessed as a function of blood marker concentrations and Lp-PLA 2 by Cox proportional hazards multivariable regression adjusted for significant clinical covariates. Results: Factor analysis revealed that Lp-PLA 2 was associated with one factor dominated by cholesterol and apolipoprotein B and another factor dominated by HDL-cholesterol and triglycerides, with little association with an inflammatory factor dominated by C-reactive protein. Multivariable analysis demonstrated as significant and independent predictors of risk of secondary coronary events only apolipoprotein B in a

Lipoprotein‐Associated Phospholipase A 2 Activity Is a Marker of Risk But Not a Useful Target for Treatment in Patients With Stable Coronary Heart Disease

“…Prior to the current study, several lines of evidence supported Lp‐PLA 2 activity as a risk indicator of adverse outcomes both in patients with stable CHD and in the general population in addition to being potentially involved in the development of atherosclerosis and vulnerable plaque at the tissue level 6, 7, 8, 9, 22, 23, 24, 25, 26, 27. Furthermore, in 2 case–control studies, natural deficiency of Lp‐PLA 2 activity due to carriage of the V279F‐null allele in the Lp‐PLA 2 gene was associated with a lower risk of developing CHD 30.…”

Glycoprotein Ibα Polymorphism T145M, Elevated Lipoprotein-Associated Phospholipase A2, and Hypertriglyceridemia Predict Risk for Recurrent Coronary Events in Diabetic Postinfarction Patients

“…For the diabetic study group, there were a total of 199 patients, with 173 having complete serum biomarker levels and 145 with complete biomarker levels as well as T145M genotyping. Reference populations comprised nondiabetic patients of the THROMBO study (12). Details of the entire THROMBO study population have been reported previously (13), and, as noted, the study was carried out with approval of and according to guidelines of the research subjects review boards.…”

Incorporating biomarkers into clinical trials in cardiovascular medicine

“…The prognostic value of Lp-PLA 2 for cardiovascular events has also been demonstrated in patients with stable CAD. [91][92][93] In addition to predicting the risk of a cardiac event, Lp-PLA 2 has been suggested as a risk predictor for restenosis. In a recent study involving 326 patients eligible for stent placement, elevated baseline levels of Lp-PLA 2 (200 ng/mL) were associated with an increased risk for restenosis after 1 year.…”