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(Arteriosclerosis, Thrombosis, and Vascular Biology. 2007;27:1411.)
© 2007 American Heart Association, Inc.

Atherosclerosis and Lipoproteins

Elevated Lp-PLA₂ Levels Add Prognostic Information to the Metabolic Syndrome on Incidence of Cardiovascular Events Among Middle-Aged Nondiabetic Subjects

Margaretha Persson; Bo Hedblad; Jeanenne J. Nelson; Göran Berglund

From the Department of Clinical Sciences, Internal Medicine Research Group (M.P., G.B.) and Epidemiological Research Group (B.H.), University Hospital Malmö, Lund University, Sweden; and Worldwide Epidemiology (J.J.N.), GlaxoSmithKline, Research Triangle Park, NC.

Correspondence to Margaretha Persson, Clinical Research unit, University Hospital Malmö, Entrance 33, level 2, SE-205 02 Malmö, Sweden. E-mail margaretha.m.persson{at}skane.se

Background— To explore potential interrelationships between lipoprotein-associated phosholipase A2 (Lp-PLA₂)_, the metabolic syndrome (MetS), and incident cardiovascular disease (CVD).

Methods and Results— MetS was defined by the National Cholesterol Education Program Adult treatment Panel III criteria in 4480 nondiabetic Malmö Diet and Cancer Study subjects without history of CVD. Incidence of first CVD event (stroke [130 cases] or myocardial infarction [131]) was monitored over 10 years of follow-up. Lp-PLA₂ activity and mass were significantly higher in subjects with MetS. Lp-PLA₂ activity compared with Lp-PLA₂ mass was more strongly correlated to individual components and increased more linearly with number of MetS components. Elevated Lp-PLA₂ activity (top compared with bottom tertile), but not elevated Lp-PLA₂ mass, increased risk for incident CVD (relative risk, RR: 1.54, 95% CI 1.07 to 2.24), as did MetS (1.42, 1.06 to 1.90) after taking possible confounders into account. Relative to those without either elevated Lp-PLA₂ activity or MetS, combination of MetS and elevated Lp-PLA₂ activity increased risk for CVD (1.97, 1.34 to 2.90). Elevated Lp-PLA₂ activity without MetS increased risk for CVD (1.40, 1.03 to 1.92) but not MetS without elevated Lp-PLA₂ activity (1.46, 0.94 to 2.27).

Conclusion— Lp-PLA₂ is associated to the MetS. Higher plasma levels of Lp-PLA₂ increased risk for incident CVD regardless of MetS. The simultaneous presence of elevated Lp-PLA₂ activity and MetS may identify an especially high risk individual.

To explore potential interrelationship between Lp-PLA2 and the Metabolic syndrome, in 4480 subjects from the Malmö Diet and Cancer Study, and incident cardiovascular disease. Lp-PLA2 is associated to MetS but increases risk for incident CVD regardless of MetS. Presence of both elevated Lp-PLA2 and MetS may identify an especially high risk individual.

Key Words: metabolic syndrome • cardiovascular risk • cohort study • Lp-PLA₂

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