Lp-PLA2: A new target for statin therapy.

Inflammation plays an important role in atherogenesis and plaque vulnerability. Inflammatory-type markers have been evaluated for their association with atherosclerotic vascular disease and their ability to improve cardiovascular disease (CVD) risk stratification. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is a vascular-specific inflammatory enzyme that increases the risk of CVD events and stroke approximately twofold. A consensus panel recently recommended the measurement of Lp-PLA(2) in moderate-risk and high-risk patients for improved risk stratification and modification of low-density lipoprotein target levels. Lipid-lowering agents, particularly statins, lower Lp-PLA(2) mass and activity; therefore, Lp-PLA(2) may represent an important target of lipid-lowering therapy for reducing the inflammatory nature of atherosclerosis and plaque vulnerability. It is unknown whether lowering inflammatory markers such as Lp-PLA(2) will have a direct benefit on CVD events and mortality. A large morbidity and mortality trial was recently initiated to evaluate the long-term safety and efficacy of darapladib, an Lp-PLA(2) antagonist, in patients with high-risk coronary heart disease.