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COMMENTARY
Year : 2013  |  Volume : 138  |  Issue : 6  |  Page : 832-833

Is lipoprotein-associated phospholipase A2 correlated with cardiovascular risk in European women?


Nutrition & Diabetes Department Hospital Durand, Buenos Aires, Argentina

Date of Web Publication11-Feb-2014

Correspondence Address:
V Hirschler
Nutrition & Diabetes Department Hospital Durand, Buenos Aires
Argentina
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Source of Support: None, Conflict of Interest: None


PMID: 24521623

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How to cite this article:
Hirschler V. Is lipoprotein-associated phospholipase A2 correlated with cardiovascular risk in European women?. Indian J Med Res 2013;138:832-3

How to cite this URL:
Hirschler V. Is lipoprotein-associated phospholipase A2 correlated with cardiovascular risk in European women?. Indian J Med Res [serial online] 2013 [cited 2019 Dec 9];138:832-3. Available from: http://www.ijmr.org.in/text.asp?2013/138/6/832/126825

Lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) is an enzyme expressed in atherosclerotic plaques by inflammatory cells; thus, its measurement could contribute to the identification of patients with rupture-prone plaques [1] . Lp-PLA 2 is carried in the blood stream by low density lipoprotein (LDL) particles, where it is bound to small cholesterol-deplete LDL particles rather than to large cholesterol-enriched LDL particles. As the Lp-PLA 2 -LDL complex enters the vessel wall, the reduced phospholipid content of smaller LDL particles increases the oxidative susceptibility of those particles [1] .

Among the serum markers of inflammation, the Lp-PLA 2 is correlated with the progression, extension, and severity of cardiovascular disease (CVD) as well as to a greater mortality risk after coronary heart attack [2] . In fact, Lp-PLA 2 has been recommended as an inflammatory marker for CVD risk assessment in patients with moderate or high risk based on Framingham criteria [3] . However, in a large study of individuals without known CVD, the addition of Lp-PLA 2 information to the risk scores containing total cholesterol and HDL-C led to only slight improvement in CVD prediction [4] .

In this issue, Pop et al[5] provide further results of the correlations of Lp-PLA 2 and CVD risk factors. They raised the question of whether to consider this enzyme as an inflammation serum marker and a possible predictor of CVD risk in women. A large review [6] explored the associations between Lp-PLA 2 activity and cardiovascular events with data from 32 prospective studies that included just over 79 000 participants. Risk ratios for coronary heart disease and ischaemic strokes increased progressively for every increase of 1 SD in Lp-PLA 2 activity adjusted for confounding variables.The 2010 ACCF/AHA Guidelines for Assessment of Cardiovascular Risk in Asymptomatic Adults recommend Lp-PLA 2 as a reasonable inflammation serum marker for CVD risk assessment in intermediate-risk asymptomatic adults [7] . CVD is the leading cause of death in women in Europe [5] ; almost 55 per cent of female mortality is caused by CVD [5] . The authors compared three groups of patients: group 1 with 37 women with metabolic syndrome; group 2 with 27 men with metabolic syndrome; and group 3 with 26 women without metabolic syndrome. They found no significant differences in Lp-PLA 2 values between the three groups of patients. Female patients without metabolic syndrome displayed a significant inverse correlation between Lp-PLA 2 and HDL-C, whereas men with metabolic syndrome displayed a direct correlation with HOMA-IR. However, in general, they did not find significant correlations between the Lp-PLA 2 levels and the studied risk factors. Further, there was a weak direct correlation between Lp-PLA 2 levels and hsCRP in all the three groups studied [5] .

What implications does this study contribute regarding Lp-PLA 2 ?

Results on LP- PLA 2 are controversial. A recent study showed that after extensive adjustment for covariates, the relationship between Lp-PLA 2 mass and incident CVD was inverse for highest versus lowest tertile (relative risk: 0.55; 95% CI 0.39-0.79), whereas this association was direct for LpPLA 2 activity for highest versus lowest tertile (relative risk: 1.65; 1.12-2.42) [8] . A systemic review showed that there were no clear associations of Lp-PLA 2 mass or activity with insulin-resistance [9] . Even though Lp-PLA 2 promotes vascular inflammation, it also has a cardioprotective role because it is implicated in the degradation of the platelet-activating factor, a potent mediator of inflammation (which is why Lp-PLA 2 is also known as platelet-activating factor acetylhydrolase). This dual role raises the question of which role, proatherogenic or antiatherogenic, is more prominent and under which conditions [10] . Pop et al[5] found that there were no significant correlations between the Lp-PLA 2 levels and the CVD risk factors studied. Consistent with this study, a previous study in adult women showed that Lp-PLA 2 was positively associated with incident CVD, but after adjustments for CVD risk factors this association lost significance [11] . Another report demonstrated that Lp-PLA 2 in children [12] was not significantly associated with obesity whereas other inflammatory markers such as C reactive protein were associated. A recent review of individuals without known CVD showed that Lp-PLA 2 improved only to some extent CVD prediction compared to traditional markers [4] . Findings regarding the association of Lp-PLA 2 with incident CVD have been inconsistent, and its role in risk prediction is uncertain. This study also showed that even though there was a significant direct correlation between sPLA 2 levels and hsCRP in all the three groups studied, the correlation was weak. These results could be due to the small size of the sample studied or to the fact that Lp-PLA 2 could have a cardioprotective role in this group of women.

The strength of this study was the inclusion of women with and without metabolic syndrome. However, the study was underpowered. The R [2] in the regression line (sPLA 2 vs hsCRP in women with metabolic syndrome) was only 0.02, which means that only 2 per cent of the variation of the dependent variable (Lp-PLA 2 ) was explained by the independent variable (hsCRP). The major limitation of this study was the small size of the sample.

The authors [5] could not accurately conclude that Lp-PLA 2 was an inflammatory marker for cardiovascular disease risk. Furthermore, we now have more evidence that Lp-PLA 2 could have a dual role proatherogenic or antiatherogenic, and it is not clear as to which role is more prominent and under which conditions. The challenge to all researchers now is to investigate under which conditions Lp-PLA 2 could have a proatherogenic or antiatherogenic role. Further longitudinal studies in different ethnic and age groups should be performed to confirm these findings.

 
   References Top

1.Libby P, Ridker PM, Hansson GK; Leducq Transatlantic Network on Atherothrombosis. Inflammation in atherosclerosis: from pathophysiology to practice. J Am Coll Cardiol 2009; 54 : 2129-38.  Back to cited text no. 1
    
2.Lp-PLA (2) Studies Collaboration, Thompson A, Gao P, Orfei L, Watson S, Di Angelantonio E, Kaptoge S, et al. Lipoprotein-associated phospholipase A(2) and risk of coronary disease, stroke, and mortality: collaborative analysis of 32 prospective studies. Lancet 2010; 375 : 1536-44.   Back to cited text no. 2
    
3.Davidson MH, Corson MA, Alberts MJ, Anderson JL, Gorelick PB, Jones PH, et al. Consensus panel recommendation for incorporating lipoprotein-associated phospholipase A2 testing into cardiovascular disease risk assessment guidelines. Am J Cardiol 2008; 101 : 51F-57F.  Back to cited text no. 3
    
4.Emerging Risk Factors Collaboration, Di Angelantonio E, Gao P, Pennells L, Kaptoge S, Caslake M, Thompson, et al. Lipid-related markers and cardiovascular disease prediction. JAMA 2012; 307 : 2499-506.  Back to cited text no. 4
    
5.Pop D, Sitar-Tâut A, Bodisz G, Zdrenghea D, Cabanu M, Stanca L. Role of secretory phospholipase A 2 in women with metabolic syndrome. Indian J Med Res 2013; 138 : 866-72.  Back to cited text no. 5
    
6.The Lp-PLA2 Studies Collaboration. Lipoprotein-associated phospholipase A2 and risk of coronary disease, stroke, and mortality: collaborative analysis of 32 prospective studies. Lancet 2010; 375 : 1536-44.  Back to cited text no. 6
    
7.Mosca L, Benjamin EJ, Berra K, Bezanson JL, Dolor RJ, Lloyd-Jones DM, et al. Effectiveness-based guidelines for the prevention of cardiovascular disease in women - 2011 update: a guideline from the American Heart Association. Circulation 2011; 123 : 1243-62.  Back to cited text no. 7
    
8.Kizer JR, Umans JG, Zhu J, Devereux RB, Wolfert RL, Lee ET, et al. Lipoprotein-associated phospholipase A(2) mass and activity and risk of cardiovascular disease in a population with high prevalences of obesity and diabetes: the Strong Heart Study. Diabetes Care 2012; 35 : 840-7.  Back to cited text no. 8
    
9.Gregson J, Stirnadel-Farrant HA, Doobaree IU, Koro C. Variation of lipoprotein associated phospholipase A2 across demographic characteristics and cardiovascular risk factors: a systematic review of the literature. Atherosclerosis 2012; 225 : 11-21.  Back to cited text no. 9
    
10.Iribarren C. Lipoprotein-associated phospholipase A 2 and C-reactive protein for measurement of inflammatory risk: independent or complementary? Curr Cardio Risk Rep 2010; 4 : 57-67.   Back to cited text no. 10
    
11.Cook NR, Paynter NP, Manson JE, Martin LW, Robinson JG, Wassertheil-Smoller S, et al. Clinical utility of lipoprotein-associated phospholipase A 2 for cardiovascular disease prediction in a multiethnic cohort of women. Clin Chem 2012; 58 : 1352-63.  Back to cited text no. 11
    
12.Nagel G, Rapp K, Wabitsch M, Buchele G, Kroke A, Zollner I, et al. Prevalence and cluster of cardiometabolic biomarkers in overweight and obese schoolchildren: results from a large survey in southwest Germany. Clin Chem 2008; 54 : 317-25.  Back to cited text no. 12
    




 

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