title: Oxidized phospholipids, lipoprotein(a), lipoprotein-associated phospholipase A2 activity, and 10-year cardiovascular outcomes: prospective results from the Bruneck study.
abstract: BACKGROUND
  Oxidized phospholipids (OxPL) circulate on apolipoprotein B-100 particles (OxPL/apoB), and primarily on Lp(a) lipoprotein (a) [Lp(a)]. The relationship of OxPL/apoB levels to future cardiovascular events is not known.
  
  
  RESULTS
  The Bruneck study is a prospective population-based survey of 40- to 79-year-old men and women recruited in 1990. Plasma levels of OxPL/apoB and lipoprotein (a) [Lp(a)] were measured in 765 subjects in 1995 and incident cardiovascular disease (CVD), defined as cardiovascular death, myocardial infarction, stroke, and transient ischemic attack, was assessed from 1995 to 2005. During the follow-up period, 82 subjects developed CVD. In multivariable analysis, which included traditional risk factors, high sensitivity C-reactive protein (hsCRP), and lipoprotein-associated phospholipase A2 (Lp-PLA2) activity, subjects in the highest tertile of OxPL/apoB had a significantly higher risk of cardiovascular events than those in the lowest tertile (hazard ratio[95% CI] 2.4[1.3 to 4.3], P=0.004). The strength of the association between OxPL/apoB and CVD risk was amplified with increasing Lp-PLA2 activity (P=0.018 for interaction). Moreover, OxPL/apoB levels predicted future cardiovascular events beyond the information provided by the Framingham Risk Score (FRS). The effects of OxPL/apoB and Lp(a) were not independent of each other but they were independent of all other measured risk factors.
  
  
  CONCLUSIONS
  This study demonstrates that OxPL/apoB levels predict 10-year CVD event rates independently of traditional risk factors, hsCRP, and FRS. Increasing Lp-PLA2 activity further amplifies the risk of CVD mediated by OxPL/apoB.
authors.affiliation: Department of Neurology, Medical University of Innsbruck, Austria.
authors.forename: Stefan
authors.initials: S
authors.lastname: Kiechl
authors.forename: Johann
authors.initials: J
authors.lastname: Willeit
authors.forename: Manuel
authors.initials: M
authors.lastname: Mayr
authors.forename: Brigitte
authors.initials: B
authors.lastname: Viehweider
authors.forename: Martin
authors.initials: M
authors.lastname: Oberhollenzer
authors.forename: Florian
authors.initials: F
authors.lastname: Kronenberg
authors.forename: Christian J
authors.initials: CJ
authors.lastname: Wiedermann
authors.forename: Sabine
authors.initials: S
authors.lastname: Oberthaler
authors.forename: Qingbo
authors.initials: Q
authors.lastname: Xu
authors.forename: Joseph L
authors.initials: JL
authors.lastname: Witztum
authors.forename: Sotirios
authors.initials: S
authors.lastname: Tsimikas
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood / Q000378:metabolism*; D000367:Age Factors; D000368:Aged; D053299:Apolipoprotein B-100 / Q000097:blood / Q000378:metabolism*; D050197:Atherosclerosis / Q000175:diagnosis / Q000453:epidemiology; D015415:Biomarkers / Q000097:blood; D003324:Coronary Artery Disease / Q000201:enzymology* / Q000453:epidemiology* / Q000503:physiopathology; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054467:Phospholipases A2; D010743:Phospholipids / Q000097:blood / Q000378:metabolism*; D011159:Population Surveillance; D011237:Predictive Value of Tests; D011336:Probability; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D012737:Sex Factors; D016019:Survival Analysis
chemical_list: D053299:Apolipoprotein B-100; D015415:Biomarkers; D010743:Phospholipids; D054467:Phospholipases A2; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase