title: Lipoprotein-associated phospholipase A2 independently predicts the angiographic diagnosis of coronary artery disease and coronary death.
abstract: BACKGROUND
  Whereas C-reactive protein (CRP) is a nonspecific marker of coronary artery disease (CAD) and cardiovascular (CV) events, Lp-PLA2 may be a nonvariable inflammatory biomarker. We evaluated the independent association of lipoprotein-associated phospholipase A2 (Lp-PLA2) to angiographic CAD and CV events adjusting for standard factors, lipids, and CRP.
  
  
  METHODS
  Lipoprotein-associated phospholipase A2 (PLAC test, diaDexus, Inc, San Francisco, CA) and CRP were measured from samples donated by consecutive consenting patients (N = 1493) enrolled in the registry of the Intermountain Heart Collaborative Study. All patients underwent coronary angiography (1996-1998) for CAD determination and were followed for 6.7 +/- 0.5 years (range 5.7-7.9 years) for CV events (death [including all-cause, CAD, and non-CAD CV death], myocardial infarction, and cerebrovascular accident).
  
  
  RESULTS
  Lipoprotein-associated phospholipase A2 weakly correlated with lipids (low-density lipoprotein: r = 0.22, P < .001; high-density lipoprotein: r = -0.13, P < .001), but not CRP (r = 0.03, P = .26). Increasing quartile (Q) of Lp-PLA2 predicted greater the presence of CAD (vs Q1) for Q2 (adjusted odds ratio [OR] 1.15, 95% CI 0.78-1.71, P = .48), for Q3 (OR 1.53, 95% CI 1.02-2.31, P = .042), and for Q4 (OR 2.44, 95% CI 1.58-3.79, P < .001), although CRP was also predictive (vs Q1, Q2: OR 1.47, P = .057; Q3: OR 1.93, P = .002; Q4: OR 3.43, P < .001). In Cox regression, Lp-PLA2 predicted CAD death (vs Q1; Q2: adjusted hazard ratio [HR] 1.27, 95% CI 0.58-2.78, P = .55; Q3: HR 2.18, 95% CI 1.04-4.57, P = .04; Q4: HR 1.73, 95% CI 0.84-3.61, P = .14).
  
  
  CONCLUSIONS
  Lipoprotein-associated phospholipase A2 was confirmed to predict the presence of CAD, even among patients undergoing coronary angiography. Uniquely, Lp-PLA2 predicted the risk of CAD death, but not all-cause death, myocardial infarction, or cerebrovascular accident.
authors.affiliation: Cardiovascular Department, LDS Hospital, Salt Lake City, UT 84143, USA.
authors.forename: Heidi T
authors.initials: HT
authors.lastname: May
authors.forename: Benjamin D
authors.initials: BD
authors.lastname: Horne
authors.forename: Jeffrey L
authors.initials: JL
authors.lastname: Anderson
authors.forename: Robert L
authors.initials: RL
authors.lastname: Wolfert
authors.forename: Joseph B
authors.initials: JB
authors.lastname: Muhlestein
authors.forename: Dale G
authors.initials: DG
authors.lastname: Renlund
authors.forename: Jessica L
authors.initials: JL
authors.lastname: Clarke
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: Kolek
authors.forename: Tami L
authors.initials: TL
authors.lastname: Bair
authors.forename: Robert R
authors.initials: RR
authors.lastname: Pearson
authors.forename: Krishnankutty
authors.initials: K
authors.lastname: Sudhir
authors.forename: John F
authors.initials: JF
authors.lastname: Carlquist
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging* / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010741:Phospholipases A / Q000097:blood*; D054467:Phospholipases A2; D011237:Predictive Value of Tests
chemical_list: D010741:Phospholipases A; D054467:Phospholipases A2; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase