title: Circulating lipoprotein-associated phospholipase A2 in high-grade carotid stenosis: a new biomarker for predicting unstable plaque.
abstract: OBJECTIVE
  To test plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with high-grade carotid stenosis according to plaque histology.
  
  
  METHODS
  This cross-sectional single-centre study included patients with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) carotid stenosis, who were treated surgically. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were determined on the day of surgery. Histopathological analysis classified carotid plaque as stable or unstable, according to AHA classification.
  
  
  RESULTS
  Of the 42 patients (mean age 70.4 ± 10.5 years; 67% men), neurological symptoms were present in 16 (38%). Unstable plaques were found in 23 (55%). Median plasma level of Lp-PLA2 was significantly higher in patients with unstable plaque compared to those with stable plaque (222.4 (174.9-437.5) interquartile range (IQR) 63.5 vs. 211.1 (174.9-270.6) IQR 37.2 ng ml(-1); p = 0.02). Moreover, median Lp-PLA2 level were higher in asymptomatic patients with unstable plaque (226.8 ng ml(-1) (174.9-437.5) IQR 76.8) vs. stable plaque (206.9 ng ml(-1) (174.9-270.6) IQR 33.7; p = 0.16). Logistic regression showed that only the neurological symptoms (OR = 30.9 (3.7-244.6); p < 0.001) and the plasma Lp-PLA2 level (OR = 1.7 (1.1-12.3); p = 0.03) were independently associated with unstable carotid plaque as defined by histology.
  
  
  CONCLUSIONS
  This study showed that circulating Lp-PLA2 was increased in patients with high-grade carotid stenosis and unstable plaque. Lp-PLA2 may be a relevant biomarker to guide for invasive therapy in asymptomatic patients with carotid artery disease.
authors.affiliation: Service de Chirurgie Vasculaire, Faculté de Médecine de Marseille, Université de la Méditerranée, Assistance Publique Hôpitaux de Marseille-Hôpital de la Timone, 13005 Marseille, France. gabrielle.sarlon@ap-hm.fr
authors.forename: G
authors.initials: G
authors.lastname: Sarlon-Bartoli
authors.forename: A
authors.initials: A
authors.lastname: Boudes
authors.forename: C
authors.initials: C
authors.lastname: Buffat
authors.forename: M A
authors.initials: MA
authors.lastname: Bartoli
authors.forename: M D
authors.initials: MD
authors.lastname: Piercecchi-Marti
authors.forename: E
authors.initials: E
authors.lastname: Sarlon
authors.forename: L
authors.initials: L
authors.lastname: Arnaud
authors.forename: Y
authors.initials: Y
authors.lastname: Bennis
authors.forename: B
authors.initials: B
authors.lastname: Thevenin
authors.forename: C
authors.initials: C
authors.lastname: Squarcioni
authors.forename: F
authors.initials: F
authors.lastname: Nicoli
authors.forename: F
authors.initials: F
authors.lastname: Dignat-George
authors.forename: F
authors.initials: F
authors.lastname: Sabatier
authors.forename: P E
authors.initials: PE
authors.lastname: Magnan
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 / Q000378:metabolism; D016893:Carotid Stenosis / Q000201:enzymology*; D003430:Cross-Sectional Studies; D016894:Endarterectomy, Carotid; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009422:Nervous System Diseases / Q000150:complications; D011446:Prospective Studies
chemical_list: D015415:Biomarkers; D002097:C-Reactive Protein; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase