Clinical review: Lipoprotein-associated phospholipase A2, a novel inflammatory biomarker and independent risk predictor for cardiovascular disease.

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a member of the phospholipase A2 superfamily, a family of enzymes that hydrolyze phospholipids. Circulating Lp-PLA2 is a marker of inflammation that plays a critical role in atherogenesis; its inhibition may have antiatherogenic effects. Epidemiological data have consistently demonstrated the association of increased levels of Lp-PLA2 with increased risk of coronary heart disease (CHD). In general, studies from the West of Scotland Coronary Prevention Study, Monitoring Trends and Determinants in Cardiovascular Diseases, and Rotterdam cohorts have shown that the association of Lp-PLA2 with CHD is not attenuated upon multivariate analysis with traditional risk factors and other inflammatory markers. In addition, in the Atherosclerosis Risk in Communities cohort, Lp-PLA2 was particularly useful in identifying CHD risk among patients with a baseline low-density lipoprotein less than 130 mg/dl. Studies in subjects with coronary artery disease have also shown associations between Lp-PLA2 and cardiovascular risk. Polymorphisms of the Lp-PLA2 gene have been reported, with varying significance, in Japanese and Caucasian populations. Overall, epidemiological studies suggest that measurement of Lp-PLA2 in plasma may be useful in identifying individuals at high risk for cardiac events.