High lipoprotein-associated phospholipase A2 is a risk factor for recurrent coronary events in postinfarction patients

Background: Recent studies demonstrate that lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is a risk factor for cardiovascular disease presumably deriving from generation of proinflammatory and proatherogenic species through its hydrolytic activity on lipoprotein-associated phospholipids. The goal of this study was to assess the relationship of Lp-PLA(2) with a set of thrombogenic, lipid, inflammatory, and metabolic blood markers and to determine whether plasma LpPLA(2) is a risk factor for recurrent coronary events in postinfarction patients. Methods: Factor analysis on the set of blood markers and Lp-PLA(2) was performed for 766 patients of the Thrombogenic Factors and Recurrent Coronary Events (THROMBO) postinfarction study. Recurrent coronary event risk was assessed as a function of blood marker concentrations and Lp-PLA(2) by Cox proportional hazards multivariable regression adjusted for significant clinical covariates. Results: Factor analysis revealed that Lp-PLA(2) was associated with one factor dominated by cholesterol and apolipoprotein B and another factor dominated by HDL-cholesterol and triglycerides, with little association with an inflammatory factor dominated by C-reactive protein. Multivariable analysis demonstrated as significant and independent predictors of risk of secondary coronary events only apolipoprotein B in a model without Lp-PLA(2) (hazard ratio, 1.66; 95% confidence interval, 1.14-2.40) and only Lp-PLA(2) in a model with Lp-PLA(2) included [1.90(1.31-2.75)]. Conclusions: Lp-PLA(2) is a significant and independent predictor of risk for recurrent coronary events in postinfarction patients, and Lp-PLA(2) is related to both hype-cholesterolemia and high triglyceride-low HDL dyslipidemia in this study population.(c) 2006 American Association for Clinical Chemistry.