title: Lipoprotein-associated phospholipase A2 activity is associated with risk of coronary heart disease and ischemic stroke: the Rotterdam Study.
abstract: BACKGROUND
  Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been proposed as an inflammatory marker of cardiovascular disease. In the present study, we investigated whether Lp-PLA2 is an independent predictor of coronary heart disease and ischemic stroke.
  
  
  RESULTS
  The Rotterdam Study is a population-based follow-up study in 7983 subjects > or =55 years of age. We performed a case-cohort study, including 308 coronary heart disease cases, 110 ischemic stroke cases, and a random sample of 1820 subjects. We used Cox proportional-hazard models with modification of the standard errors based on robust variance estimates to compute hazard ratios adjusted for age, sex, body mass index, systolic blood pressure, non-HDL cholesterol, HDL cholesterol, diabetes, smoking, alcohol consumption, cholesterol-lowering medication, white blood cell count, and C-reactive protein. Compared with the first quartile of Lp-PLA2 activity, multivariate-adjusted hazard ratios for coronary heart disease for the second, third, and fourth quartiles were 1.39 (95% CI, 0.92 to 2.10), 1.99 (95% CI, 1.32 to 3.00), and 1.97 (95% CI, 1.28 to 3.02), respectively (P for trend=0.01). Corresponding multivariate-adjusted hazard ratios for ischemic stroke were 1.08 (95% CI, 0.55 to 2.11), 1.58 (95% CI, 0.82 to 3.04), and 1.97 (95% CI, 1.03 to 3.79) (P for trend=0.03). The relation between Lp-PLA2 and coronary heart disease was present in both subjects with non-HDL cholesterol levels below the median and those with non-HDL cholesterol levels above the median.
  
  
  CONCLUSIONS
  This study shows that Lp-PLA2 activity is an independent predictor of coronary heart disease and ischemic stroke in the general population.
authors.affiliation: Department of Epidemiology and Biostatistics, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Hok-Hay S
authors.initials: HH
authors.lastname: Oei
authors.forename: Irene M
authors.initials: IM
authors.lastname: van der Meer
authors.forename: Albert
authors.initials: A
authors.lastname: Hofman
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Koudstaal
authors.forename: Theo
authors.initials: T
authors.lastname: Stijnen
authors.forename: Monique M B
authors.initials: MM
authors.lastname: Breteler
authors.forename: Jacqueline C M
authors.initials: JC
authors.lastname: Witteman
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; D000368:Aged; D002545:Brain Ischemia / Q000175:diagnosis / Q000453:epidemiology*; D002784:Cholesterol / Q000097:blood; D015331:Cohort Studies; D003327:Coronary Disease / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D010741:Phospholipases A / Q000378:metabolism*; D054467:Phospholipases A2; D012307:Risk Factors; D020521:Stroke / Q000175:diagnosis / Q000453:epidemiology*
chemical_list: D002784:Cholesterol; D010741:Phospholipases A; D054467:Phospholipases A2; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase