Lipoprotein-associated phospholipase A(2) bound on high-density lipoprotein is associated with lower risk for cardiac death in stable coronary artery disease patients: a 3-year follow-up.
OBJECTIVE
The aim of this study was to examine the prognostic value of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) associated with high-density lipoprotein (HDL) (HDL-Lp-PLA(2)) in patients with stable coronary artery disease (CAD).


BACKGROUND
Lp-PLA(2) is a novel risk factor for cardiovascular disease. It has been postulated that the role of Lp-PLA(2) in atherosclerosis may depend on the type of lipoprotein with which it is associated.


METHODS
Total plasma Lp-PLA(2) and HDL-Lp-PLA(2) mass and activity, lipids, and C-reactive protein were measured in 524 consecutive patients with stable CAD who were followed for a median of 34 months. The primary endpoint was cardiac death, and the secondary endpoint was hospitalization for acute coronary syndromes, myocardial revascularization, arrhythmic event, or stroke.


RESULTS
Follow-up data were obtained from 477 patients. One hundred twenty-three patients (25.8%) presented with cardiovascular events (24 cardiac deaths, 47 acute coronary syndromes, 28 revascularizations, 22 arrhythmic events, and 2 strokes). Total plasma Lp-PLA(2) mass and activity were predictors of cardiac death (hazard ratio [HR]: 1.013; 95% confidence interval [CI]: 1.005 to 1.021; p = 0.002; and HR: 1.040; 95% CI: 1.005 to 1.076; p = 0.025, respectively) after adjustment for traditional risk factors for CAD. In contrast, HDL-Lp-PLA(2) mass and activity were associated with lower risk for cardiac death (HR: 0.972; 95% CI: 0.952 to 0.993; p = 0.010; and HR: 0.689; 95% CI: 0.496 to 0.957; p = 0.026, respectively) after adjustment for traditional risk factors for CAD.


CONCLUSIONS
Total plasma Lp-PLA(2) is a predictor of cardiac death, while HDL-Lp-PLA(2) is associated with lower risk for cardiac death in patients with stable CAD, independently of other traditional cardiovascular risk factors.
Second Department of Cardiology, University General Hospital, Athens, Greece.
Loukianos S
LS
Rallidis
Constantinos C
CC
Tellis
John
J
Lekakis
Ioannis
I
Rizos
Christos
C
Varounis
Athanasios
A
Charalampopoulos
Maria
M
Zolindaki
Nikolaos
N
Dagres
Maria
M
Anastasiou-Nana
Alexandros D
AD
Tselepis
D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D050197:Atherosclerosis / Q000150:complications*; D008076:Cholesterol, HDL / Q000097:blood*; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications; D003643:Death; D004452:Echocardiography; D005500:Follow-Up Studies; D006760:Hospitalization; D006801:Humans; D011379:Prognosis; D012307:Risk Factors; D020521:Stroke / Q000097:blood* / Q000150:complications
D008076:Cholesterol, HDL; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase