Lipid-Related Markers and Cardiovascular Disease Prediction

Lipoprotein‐Associated Phospholipase A 2 Activity Is a Marker of Risk But Not a Useful Target for Treatment in Patients With Stable Coronary Heart Disease

“…After adjusting for both baseline characteristics and other prognostic biomarkers, Lp‐PLA 2 activity remained a significant marker of composite cardiovascular events, hospitalization for heart failure, and cardiovascular and total mortality, whereas the associations with new ischemic events such as MI and stroke were attenuated. The finding of an independent association between Lp‐PLA 2 activity and composite cardiovascular events is in accordance with most 6, 7, 8, 9, 22, 23, 24, 25, 26, 27 although not all28 previous studies of stable patients at high risk for or with established CHD. The rather weak independent association with a raised risk of cardiovascular events when adjusting for other biomarkers might be a corollary to the lack of association between Lp‐PLA 2 activity and outcomes in patients with acute coronary syndromes having pronounced elevations of other prognostic biomarkers 29…”

“…This prespecified analysis of the STABILITY trial in patients with stable CHD followed for 3.7 years on a background of optimal medical therapy verified that Lp‐PLA 2 activity is a marker of overall cardiovascular risk and total mortality in patients with stable CHD, in accordance with previous studies 6, 7, 8, 9. Dyslipidemia, male sex, current smoking, and living in the North American region were associated with higher Lp‐PLA 2 activity, in agreement with other observations 21.…”

“…Prior to the current study, several lines of evidence supported Lp‐PLA 2 activity as a risk indicator of adverse outcomes both in patients with stable CHD and in the general population in addition to being potentially involved in the development of atherosclerosis and vulnerable plaque at the tissue level 6, 7, 8, 9, 22, 23, 24, 25, 26, 27. Furthermore, in 2 case–control studies, natural deficiency of Lp‐PLA 2 activity due to carriage of the V279F‐null allele in the Lp‐PLA 2 gene was associated with a lower risk of developing CHD 30.…”

“…Biomarkers indicating myocardial dysfunction (eg, troponin, natriuretic peptides), renal dysfunction (eg, cystatin C), and inflammatory activity (eg, C‐reactive protein) are risk indicators of future cardiovascular events in healthy persons and in patients with established coronary heart disease (CHD) 2, 3, 4, 5. Higher levels of lipoprotein‐associated phospholipase A 2 (Lp‐PLA 2 ) activity have also been associated with an increased risk of coronary events in healthy elderly persons and in patients with stable CHD 6, 7, 8, 9. There is some evidence that Lp‐PLA 2 might be part of the atherosclerotic process and may contribute to plaque destabilization through inflammatory activity in the atherosclerotic lesions 10, 11, 12.…”

Association of High‐Density Lipoprotein‐Cholesterol Versus Apolipoprotein A‐I With Risk of Coronary Heart Disease: The European Prospective Investigation Into Cancer‐Norfolk Prospective Population Study, the Atherosclerosis Risk in Communities Study, and the Women's Health Study

“…Prospective studies comparing the associations of apoA‐I and HDL‐C with risk of future CHD events have shown conflicting results 12, 13. A possible explanation lies in the intricate relationship between HDL‐C and apoA‐I levels that is hard to dissect using conventional regression models.…”