title: Association of Lp-PLA2 with digital reactive hyperemia, coronary flow reserve, carotid atherosclerosis and arterial stiffness in coronary artery disease.
abstract: BACKGROUND
  Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has a powerful inflammatory and atherogenic action in the vascular wall and is an independent marker of poor prognosis in coronary artery disease (CAD). We investigate the association of Lp-PLA2 with markers of vascular dysfunction and atherosclerosis with proven prognostic value in CAD.
  
  
  METHODS
  In 111 patients with angiographically documented chronic CAD, we measured 1) carotid intima-media thickness (CIMT), 2) reactive hyperemia using fingertip peripheral arterial tonometry (RH-PAT), 3) coronary flow reserve (CFR), by Doppler echocardiography 4) pulse wave velocity (PWV) and 5) blood levels of Lp-PLA2.
  
  
  RESULTS
  Patients with Lp-PLA2 concentration >234.5 ng/ml (50th percentile) had higher CIMT (1.44 ± 0.07 vs. 1.06 ± 0.06 mm), PWV (11.0 ± 2.36 vs. 9.7 ± 2.38 m/s) and lower RH-PAT(1.24 ± 0.25 vs. 1.51 ± 0.53) and CFR (2.39 ± 0.75 vs. 2.9 ± 0.86) compared to those with lower Lp-PLA (p < 0.05 for all comparisons). Lp-PLA2 was positively associated with CIMT (regression coefficient b: 0.30 per unit of Lp-PLA2, p = 0.02), PWV (b:0.201, p = 0.04) and inversely with RHI-PAT (b: -0.371, p < 0.001) and CFR (b:-0.32, p = 0.002). In multivariate analysis, Lp-PLA2 was an independent determinant of RHI-PAT, CFR, CIMT and PWV in a model including age, sex, smoking, diabetes, dyslipidemia and hypertension (p < 0.05 for all vascular markers). Lp-PLA2, RHI-PAT and CFR were independent predictors of cardiac events during a 3-year follow-up.
  
  
  CONCLUSIONS
  Elevated Lp-PLA2 concentration is related with endothelial dysfunction, carotid atherosclerosis, impaired coronary flow reserve and increased arterial stiffness and adverse outcome in CAD patients. These findings suggest that the prognostic role of Lp-PLA2 in chronic CAD may be explained by a generalized detrimental effect of this lipase on endothelial function and arterial wall properties.
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece. Electronic address: ignoik@gmail.com.
authors.forename: Ignatios
authors.initials: I
authors.lastname: Ikonomidis
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Nikolaos N P
authors.initials: NN
authors.lastname: Kadoglou
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Vlassis
authors.initials: V
authors.lastname: Tritakis
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Paraskevaidis
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Kleanthi
authors.initials: K
authors.lastname: Dimas
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Paraskevi
authors.initials: P
authors.lastname: Trivilou
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Ioannis
authors.initials: I
authors.lastname: Papadakis
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Stavros
authors.initials: S
authors.lastname: Tzortzis
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Helen
authors.initials: H
authors.lastname: Triantafyllidi
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Parissis
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: Maria
authors.initials: M
authors.lastname: Anastasiou-Nana
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attikon Hospital, Athens, Greece.
authors.forename: John
authors.initials: J
authors.lastname: Lekakis
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000097:blood*; D015415:Biomarkers / Q000097:blood; D002340:Carotid Artery Diseases / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D059168:Carotid Intima-Media Thickness; D003324:Coronary Artery Disease / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D003326:Coronary Circulation; D003430:Cross-Sectional Studies; D005260:Female; D005385:Fingers; D006801:Humans; D006940:Hyperemia / Q000097:blood* / Q000150:complications / Q000503:physiopathology*; D008297:Male; D008875:Middle Aged; D063177:Pulse Wave Analysis; D059289:Vascular Stiffness
chemical_list: D015415:Biomarkers; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase
keywords: Carotid intima-media thickness; Coronary artery disease; Coronary flow reserve; Lp-PLA2; Prognosis; Pulse wave velocity; Reactive hyperemia index