Lipoprotein-associated phospholipase A2 independently predicts the angiographic diagnosis of coronary artery disease and coronary death

May, Heidi T.; Horne, Benjamin D.; Anderson, Jeffrey L.; Wolfert, Robert L.; Muhlestein, Joseph B.; Renlund, Dale G.; Clarke, Jessica L.; Kolek, Matthew J.; Bair, Tami L.; Pearson, Robert R.; Sudhir, Krishnankutty; Carlquist, John F.

doi:10.1016/j.ahj.2006.01.011

« Previous Next »American Heart Journal
Volume 152, Issue 5 , Pages 997-1003, November 2006

Lipoprotein-associated phospholipase A₂ independently predicts the angiographic diagnosis of coronary artery disease and coronary death

Heidi T. May, MSPH
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
Benjamin D. Horne, PhD, MPH
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
Jeffrey L. Anderson, MD, FACC
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
- Cardiology Division, University of Utah, Salt Lake City, UT
Robert L. Wolfert, PhD
- diaDexus Inc, San Francisco, CA
Joseph B. Muhlestein, MD, FACC
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
- Cardiology Division, University of Utah, Salt Lake City, UT
Dale G. Renlund, MD, FACC
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
- Cardiology Division, University of Utah, Salt Lake City, UT
Jessica L. Clarke
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
Matthew J. Kolek, BS
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
Tami L. Bair, BS
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
Robert R. Pearson, BS
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
Krishnankutty Sudhir, MD, PhD
- diaDexus Inc, San Francisco, CA
John F. Carlquist, PhD
- Cardiovascular Department, LDS Hospital, Salt Lake City, UT
- Cardiology Division, University of Utah, Salt Lake City, UT
- Reprint requests: John F. Carlquist, PhD, Cardiovascular Department, LDS Hospital, 8th Avenue and C Street, Salt Lake City, UT 84143.

Received 3 August 2005; accepted 25 January 2006. published online 24 June 2006.

Background

Whereas C-reactive protein (CRP) is a nonspecific marker of coronary artery disease (CAD) and cardiovascular (CV) events, Lp-PLA₂ may be a nonvariable inflammatory biomarker. We evaluated the independent association of lipoprotein-associated phospholipase A₂ (Lp-PLA₂) to angiographic CAD and CV events adjusting for standard factors, lipids, and CRP.

Methods

Lipoprotein-associated phospholipase A₂ (PLAC test, diaDexus, Inc, San Francisco, CA) and CRP were measured from samples donated by consecutive consenting patients (N = 1493) enrolled in the registry of the Intermountain Heart Collaborative Study. All patients underwent coronary angiography (1996-1998) for CAD determination and were followed for 6.7 ± 0.5 years (range 5.7-7.9 years) for CV events (death [including all-cause, CAD, and non-CAD CV death], myocardial infarction, and cerebrovascular accident).

Results

Lipoprotein-associated phospholipase A₂ weakly correlated with lipids (low-density lipoprotein: r = 0.22, P < .001; high-density lipoprotein: r = −0.13, P < .001), but not CRP (r = 0.03, P = .26). Increasing quartile (Q) of Lp-PLA₂ predicted greater the presence of CAD (vs Q1) for Q2 (adjusted odds ratio [OR] 1.15, 95% CI 0.78-1.71, P = .48), for Q3 (OR 1.53, 95% CI 1.02-2.31, P = .042), and for Q4 (OR 2.44, 95% CI 1.58-3.79, P < .001), although CRP was also predictive (vs Q1, Q2: OR 1.47, P = .057; Q3: OR 1.93, P = .002; Q4: OR 3.43, P < .001). In Cox regression, Lp-PLA₂ predicted CAD death (vs Q1; Q2: adjusted hazard ratio [HR] 1.27, 95% CI 0.58-2.78, P = .55; Q3: HR 2.18, 95% CI 1.04-4.57, P = .04; Q4: HR 1.73, 95% CI 0.84-3.61, P = .14).

Conclusion

Lipoprotein-associated phospholipase A₂ was confirmed to predict the presence of CAD, even among patients undergoing coronary angiography. Uniquely, Lp-PLA₂ predicted the risk of CAD death, but not all-cause death, myocardial infarction, or cerebrovascular accident.