Lipoprotein-associated phospholipase A2 activity and risk of recurrent stroke.
BACKGROUND
Mass levels of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), a leukocyte-derived enzyme involved in the metabolism of low-density lipoprotein to pro-inflammatory mediators, are associated with prognosis after stroke. Lp-PLA(2) mass correlates only moderately with levels of Lp-PLA(2) activity. The relationship of Lp-PLA(2) activity to risk of stroke recurrence is unknown. We hypothesized that Lp-PLA(2) activity levels would predict risk of recurrence.


METHODS
In the population-based Northern Manhattan Stroke Study, first ischemic stroke patients >or=40 years were followed for recurrent stroke. Levels of Lp-PLA(2) activity were assessed in 467 patients, and categorized by quartile. Cox proportional hazard models were used to calculate hazard ratios (HR) and 95% confidence intervals (95% CI) for risk of recurrent stroke associated with marker quartiles after adjusting for demographics, vascular risk factors, and high-sensitivity C-reactive protein (hsCRP).


RESULTS
Mean age was 68.9 +/- 12.7 years; 54.6% were women; 53.3% Hispanic, 27.2% black, and 17.8% white. Median follow-up was 4.0 years, and there were 80 recurrent strokes. Compared to the lowest quartile of Lp-PLA(2) activity, those in the highest had an increased risk of recurrent stroke (adjusted HR 2.54, 95% CI 1.01-6.39).


CONCLUSIONS
Stroke patients with Lp-PLA(2) activity levels in the highest quartile, compared to those in the lowest quartile, had an increased risk of recurrence after first ischemic stroke. Further studies are warranted to determine whether this biomarker has clinical utility in determining high-risk populations of stroke survivors, and whether anti-inflammatory strategies that reduce levels of activity of Lp-PLA(2) reduce the risk of stroke recurrence.
Elkind
Mitchell S V
MS
Department of Neurology, College of Physicians and Surgeons, Columbia University, and Columbia-Presbyterian Medical Center, New York Presbyterian Hospital, New York, NY, USA. mse13@columbia.edu
Tai
Wanling
W
Coates
Kristen
K
Paik
Myunghee C
MC
Sacco
Ralph L
RL
D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000378:metabolism*; D000367:Age Factors; D000368:Aged; D015415:Biomarkers; D002097:C-Reactive Protein / Q000378:metabolism; D015331:Cohort Studies; D003920:Diabetes Mellitus / Q000453:epidemiology; D005006:Ethnicity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006949:Hyperlipidemias / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D012372:ROC Curve; D012008:Recurrence; D012307:Risk Factors; D012907:Smoking / Q000453:epidemiology; D020521:Stroke / Q000201:enzymology* / Q000453:epidemiology* / Q000473:pathology; D016896:Treatment Outcome
D015415:Biomarkers; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase