Increased blood levels of Lp-PLA2 have been linked to increased risk for...

Lp-PLA2 (Lipoprotein-Associated Phospholipase A2)

Clinical Use

Assess risk of coronary heart disease and cardiovascular disease Assess risk of stroke

Clinical Background

Traditional markers of lipidemia identify only about half of the individuals at risk of cardiovascular disease (CVD).1 Atherosclerosis is now recognized as an inflammatory disease, and inflammatory markers, most notably high-sensitivity C-reactive protein (hs-CRP), have been shown to identify additional individuals who are at risk. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is another marker of vascular inflammation, and because it is not associated with systemic inflammation it is more vascular-specific than is CRP.2 It is produced by macrophages and other inflammatory cells and is found in atherosclerotic lesions. Increased blood levels of Lp-PLA2 have been linked to increased risk for: 1) cerebral thrombosis,3 2) first4 and recurrent5 coronary events, 3) adverse prognosis after acute coronary syndrome,6 and 4) CVD associated with metabolic syndrome7 or type 2 diabetes mellitus.8 Evidence from more than 25 prospective studies has shown an approximate doubling of risk for coronary artery disease (CAD), CVD, and stroke when comparing Lp-PLA2 values in the top quintile versus the bottom quintile.2 The predictive value typically remains after adjustment for LDL-cholesterol and other established CVD risk factors.2 Thus, a consensus panel has recommended testing Lp-PLA2 as an adjunct to traditional risk factor assessment in individuals with moderate or high risk of CVD as defined by Framingham risk scores.9 According to the recommendation, an elevated Lp-PLA2 (ie, >200 ng/mL) suggests an individual’s risk is actually higher than that determined using Framingham risk scores, and more intensive therapy would be appropriate.9 For example, an individual with a moderate Framingham risk score and an elevated Lp-PLA2 may be reclassified as being at high risk, and the LDL-cholesterol goal would then be reduced from <130 dl.="" dl="" mg="" sup="" to="">9

The individual would also receive recommendations for more intensive life-style changes. Similarly, in individuals with an elevated Lp-PLA2 and high Framingham risk score, the LDL-cholesterol goal would be reduced from <100 dl.="" dl="" mg="" sup="" to="">9 Note that others have recommended a Lp-PLA2 cut point of 235 ng/mL, which coincides with the 50th percentile of the U.S. population, rather than the 200 ng/mL recommended by the consensus panel.¹⁰

The consensus panel further recommends use of Lp-PLA2 to refine risk for stroke.⁹

Screening with both Lp-PLA2 and hs-CRP may provide a better risk assessment for CVD and stroke than using either test alone. Elevated levels of Lp-PLA2 and hs-CRP were independent and complementary in identifying increased risk for future coronary events among healthy middle-aged men⁴ and patients with CVD.¹¹

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Read the complete article here.

 

Also listen to The Tuesday Talk Show where Dr William Blanchet discusses Lp-PLA2 here.