title: Association of Lp-PLA2-A and early recurrence of vascular events after TIA and minor stroke.
abstract: OBJECTIVE
  To determine the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) measured in the acute period and the short-term risk of recurrent vascular events in patients with TIA or minor stroke.
  
  
  METHODS
  We measured Lp-PLA2 activity (Lp-PLA2-A) in a subset of 3,201 participants enrolled in the CHANCE (Clopidogrel in High-Risk Patients with Acute Non-disabling Cerebrovascular Events) trial. Participants with TIA or minor stroke were enrolled within 24 hours of symptom onset and randomized to single or dual antiplatelet therapy. In the current analysis, the primary outcome was defined as the composite of ischemic stroke, myocardial infarction, or death within 90 days.
  
  
  RESULTS
  The composite endpoint occurred in 299 of 3,021 participants (9.9%). The population average Lp-PLA2-A level was 209 ± 59 nmol/min/mL (95% confidence interval [CI] 207-211). Older age, male sex, and current smoking were associated with higher Lp-PLA2-A levels. Lp-PLA2-A was significantly associated with the primary endpoint (adjusted hazard ratio 1.07, 95% CI 1.01-1.13 for every 30 nmol/min/mL increase). Similar results were seen for ischemic stroke alone. Adjustment for low-density lipoprotein cholesterol attenuated the association between Lp-PLA2-A and the primary endpoint (adjusted hazard ratio 1.04, 95% CI 0.97-1.11 for every 30 nmol/min/mL increase).
  
  
  CONCLUSIONS
  Higher levels of Lp-PLA2-A in the acute period are associated with increased short-term risk of recurrent vascular events.
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Jinxi
authors: J
authors: Lin
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Hongwei
authors: H
authors: Zheng
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Brett L
authors: BL
authors: Cucchiara
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Jiejie
authors: J
authors: Li
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Xingquan
authors: X
authors: Zhao
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Xianhong
authors: X
authors: Liang
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Chunxue
authors: C
authors: Wang
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Hao
authors: H
authors: Li
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: Michael T
authors: MT
authors: Mullen
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX.
authors: S Claiborne
authors: SC
authors: Johnston
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX. yongjunwang1962@gmail.com yilong528@gmail.com.
authors: Yilong
authors: Y
authors: Wang
authors: From the Department of Neurology (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Tiantan Hospital, Capital Medical University; China National Clinical Research Center for Neurological Diseases (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang); Center of Stroke (J. Lin, H.Z., J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), Beijing Institute for Brain Disorders; Beijing Key Laboratory of Translational Medicine for Cerebrovascular Disease (J. Lin, J. Li, X.Z., X.L., C.W., H.L., Yilong Wang, Yongjun Wang), China; Department of Neurology (B.L.C., M.T.M.), University of Pennsylvania, Philadelphia; and Dell Medical School (S.C.J.), University of Texas-Austin, TX. yongjunwang1962@gmail.com yilong528@gmail.com.
authors: Yongjun
authors: Y
authors: Wang
mesh_terms: D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase / Q000378:metabolism*; D000368:Aged; D015415:Biomarkers; D015331:Cohort Studies; D005260:Female; D006801:Humans; D002546:Ischemic Attack, Transient / Q000188:drug therapy / Q000201:enzymology*; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000201:enzymology* / Q000401:mortality; D010975:Platelet Aggregation Inhibitors / Q000627:therapeutic use; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012008:Recurrence; D012307:Risk Factors; D055502:Secondary Prevention; D012720:Severity of Illness Index; D020521:Stroke / Q000188:drug therapy / Q000201:enzymology* / Q000401:mortality
chemical_list: D015415:Biomarkers; D010975:Platelet Aggregation Inhibitors; D043203:1-Alkyl-2-acetylglycerophosphocholine Esterase; C526684:PLA2G7 protein, human