title: Lipoprotein-associated phospholipase A(2), inflammatory biomarkers, and risk of cardiovascular disease in the Prospective Study of Pravastatin in the Elderly at Risk (PROSPER).
abstract: OBJECTIVE
  Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is an inflammatory biomarker that circulates mainly bound to LDL. We evaluated the association of Lp-PLA(2) with vascular events in the elderly where the importance of LDL is diminished as a risk factor for coronary disease.
  
  
  METHODS
  Mass and activity of Lp-PLA(2) were related to risk over 3.2 years for vascular events (definite or suspected death from CHD, non-fatal MI, fatal or non-fatal stroke) in the 2804 men and 3000 women age 70-82 years in the Prospective Study of Pravastatin in the Elderly (PROSPER).
  
  
  RESULTS
  Lp-PLA(2) showed a moderate, positive association with risk of a vascular event with hazard ratios of 1.25 (confidence interval (CI) 1.02-1.54) for mass and 1.39 (CI 1.14-1.70) for activity for top versus bottom quartile. Risk associations were attenuated when classical risk factors, lipids and inflammatory markers - C-reactive protein and white cell count - were included in the models. Lp-PLA(2) was unrelated to stroke risk. Inclusion of all three inflammatory markers in multivariate models negated the association of HDL cholesterol with risk (hazard ratio 0.98; CI 0.88-1.10) and increased prediction of coronary events; the C statistic rose from 63.2% to 64.4% (P<0.001).
  
  
  CONCLUSIONS
  In elderly people Lp-PLA(2), alongside other inflammatory indices, is a potential biomarker for vascular events, particularly CHD.
authors.affiliation: Division of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow G11 6NT, UK. muriel.caslake@clinmed.gla.ac.uk
authors.forename: Muriel J
authors.initials: MJ
authors.lastname: Caslake
authors.forename: Chris J
authors.initials: CJ
authors.lastname: Packard
authors.forename: Michele
authors.initials: M
authors.lastname: Robertson
authors.forename: Josephine
authors.initials: J
authors.lastname: Cooney
authors.forename: Jeanenne J
authors.initials: JJ
authors.lastname: Nelson
authors.forename: Ian
authors.initials: I
authors.lastname: Ford
authors.forename: Allan
authors.initials: A
authors.lastname: Gaw
authors.forename: J Wouter
authors.initials: JW
authors.lastname: Jukema
authors.forename: Peter W
authors.initials: PW
authors.lastname: Macfarlane
authors.forename: David J
authors.initials: DJ
authors.lastname: Stott
authors.forename: James
authors.initials: J
authors.lastname: Shepherd
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D000368:Aged; D000369:Aged, 80 and over; D015415:Biomarkers / Q000097:blood*; D002097:C-Reactive Protein / Q000032:analysis; D003327:Coronary Disease / Q000209:etiology*; D005260:Female; D006801:Humans; D007249:Inflammation / Q000097:blood; D008055:Lipids / Q000097:blood; D008074:Lipoproteins / Q000097:blood; D008297:Male; D012307:Risk Factors
chemical_list: D015415:Biomarkers; D008055:Lipids; D008074:Lipoproteins; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase