title: The importance of age and statin therapy in the interpretation of Lp-PLA(2) in ACS patients, and relation to CRP.
abstract: C-reactive protein (CRP) is a marker of arterial inflammation while lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is related to plaque instability. The aim of this study was to evaluate the correlation between the risk of unstable plaque presenting as acute coronary syndrome (ACS) and Lp-PLA(2), and to assess the influence of statins on interpretation of Lp-PLA(2). A total of 362 consecutive patients presenting to the emergency department (ED) with acute chest pain suggestive of ACS were evaluated by cardiologists as STEMI, NSTEMI, or unstable angina, and non-ACS. Serum biomarkers measured on admission: troponin I, C-reactive protein (Abbott), and Lp-PLA(2) (DiaDexus). Four groups were defined according to the final diagnosis and history of statin medication: ACS/statin-; ACS/statin+; non-ACS/statin-; non-ACS/statin+. Lp-PLA(2) was highest in ACS/statin- group; statins decreased Lp-PLA(2) both in ACS and non-ACS of about 20 %. Lp-PLA(2) was higher in ACS patients in comparison with non-ACS patients group without respect to statin therapy (p<0.001). Lp-PLA(2) predicted worse outcome (in terms of acute coronary syndrome) effectively in patients up to 62 years; limited prediction was found in older patients. C-reactive protein (CRP) failed to discriminate four groups of patients. Statin therapy and age should be taken into consideration while interpreting Lp-PLA(2) concentrations and lower cut-off values should be used for statin-treated persons.
authors.affiliation: Department of Laboratory Methods, Institute for Clinical and Experimental Medicine, Prague, Czech Republic. anja@ikem.cz.
authors.forename: J
authors.initials: J
authors.lastname: Franeková
authors.forename: J
authors.initials: J
authors.lastname: Kettner
authors.forename: Z
authors.initials: Z
authors.lastname: Kubíček
authors.forename: A
authors.initials: A
authors.lastname: Jabor
mesh_terms: D054058:Acute Coronary Syndrome / Q000097:blood* / Q000175:diagnosis*; D000368:Aged; D000375:Aging / Q000378:metabolism* / Q000502:physiology; D019540:Area Under Curve; D002097:C-Reactive Protein / Q000032:analysis*; D005260:Female; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D058226:Plaque, Atherosclerotic / Q000097:blood* / Q000188:drug therapy*; D011237:Predictive Value of Tests; D013869:Thiolester Hydrolases / Q000097:blood*; D016896:Treatment Outcome; D019210:Troponin I / Q000097:blood
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors; D019210:Troponin I; D002097:C-Reactive Protein; C581317:LYPLA2 protein, human; D013869:Thiolester Hydrolases