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Lipids, Lipoproteins, and Cardiovascular Risk Factors |
1 Department of Clinical Chemistry, University Medical Center Freiburg, Germany.
2 Cardiology Group, Frankfurt-Sachsenhausen, Germany.
3 LURIC Study Nonprofit LLC, Freiburg, Germany.
4 Division of Endocrinology, Department of Medicine, University Hospital, Ulm, Germany.
5 Synlab Center of Laboratory Diagnostics, Heidelberg, Germany.
aAddress correspondence to this author at: Department of Medicine, Hugstetter Straße 55, D-79106 Freiburg, Germany. Fax 49-761-270-3444; e-mail kwinkler{at}ukl.uni-freiburg.de.
Background: Lipoprotein-associated phospholipase A2 (LpPLA2), also denoted as platelet-activating factor acetylhydrolase, is a lipoprotein-bound enzyme involved in inflammation and atherosclerosis. In this cohort study we investigated LpPLA2 activity to predict cardiac mortality in patients scheduled for coronary angiography.
Methods: LpPLA2 activity was determined in 2513 patients with and in 719 patients without angiographically confirmed coronary artery disease (CAD).
Results: During the median observation period of 5.5 years, 501 patients died. In patients with tertiles of LpPLA2 activity of 420–509 U/L or
510 U/L, unadjusted hazard ratios (HRs) for cardiac death were 1.7 (95% CI 1.3–2.4; P = 0.001), and 1.9 (95% CI 1.4–2.5; P <0.001), respectively, compared with patients with LpPLA2 activity
419 U/L. After we accounted for established risk factors and included angiographic CAD status, high-sensitivity C-reactive protein (hsCRP), and N-terminal pro-B-type natriuretic peptide, the 3rd tertile of LpPLA2 activity predicted cardiac 5-year mortality with an HR of 2.0 (95% CI 1.4–3.1; P = 0.001). LpPLA2 activity increased the adjusted risk for cardiac death by 2-fold in patients with hsCRP <3 mg/L in the 2nd (HR 2.4, 95% CI 1.4–4.2; P = 0.002) and 3rd (HR 2.1, 95% CI 1.1–4.0; P = 0.02) tertiles of LpPLA2 activity and in patients with hsCRP of 3–10 mg/L in the 3rd tertile (HR 1.9, 95% CI 1.0–3.6; P = 0.03) of LpPLA2 activity.
Conclusions: LpPLA2 activity predicts risk for 5-year cardiac mortality independently from established risk factors and indicates risk for cardiac death in patients with low and medium-high hsCRP concentrations. Therefore, LpPLA2 activity may provide information for the identification and management of patients at risk beyond established risk stratification strategies.
The following articles in journals at HighWire Press have cited this article:
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S. Tsimikas, J. Willeit, M. Knoflach, M. Mayr, G. Egger, M. Notdurfter, J. L. Witztum, C. J. Wiedermann, Q. Xu, and S. Kiechl Lipoprotein-associated phospholipase A2 activity, ferritin levels, metabolic syndrome, and 10-year cardiovascular and non-cardiovascular mortality: results from the Bruneck study Eur. Heart J., January 1, 2009; 30(1): 107 - 115. [Abstract] [Full Text] [PDF] |
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