title: Lipoprotein-associated phospholipase A2 activity and risk of recurrent stroke.
abstract: 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.
authors.affiliation: 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
authors.forename: Mitchell S V
authors.initials: MS
authors.lastname: Elkind
authors.forename: Wanling
authors.initials: W
authors.lastname: Tai
authors.forename: Kristen
authors.initials: K
authors.lastname: Coates
authors.forename: Myunghee C
authors.initials: MC
authors.lastname: Paik
authors.forename: Ralph L
authors.initials: RL
authors.lastname: Sacco
mesh_terms: 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
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase