Lipoprotein-Associated Phospholipase A₂ and Risk of Stroke

Risk ratios for ischemic stroke based on lipoprotein-associated phospholipase A₂ (Lp-PLA₂) level and systolic blood pressure (SBP). In the Atherosclerosis Risk in Community (ARIC) study of apparently healthy middle-aged men and women, Lp-PLA₂ increases the risk for ischemic stroke in borderline hypertension. An Lp-PLA₂ value above the median plus SBP in the top tertile (>130 mm Hg) further increased stroke risk by a cumulative 6- to 7-fold. *p = 0.03, **p ≤0.005, ^†p <0.0001 Lp-PLA₂ above median vs Lp-PLA₂ below median. (Reprinted with permission from Ballantyne CM, 2007.¹³)

Association of lipoprotein-associated phospholipase A₂ (Lp-PLA₂) with high risk of recurrent stroke after first ischemic stroke. Elevated Lp-PLA₂ drawn in the acute setting of first stroke in the Northern Manhattan Stroke Study (NOMAS) independently predicted a doubling of risk for recurrent stroke and almost a doubling of risk for any hard cardiovascular event, including myocardial infarction, stroke, or vascular death. In contrast, high-sensitivity C-reactive protein (hs-CRP) was not associated with risk for recurrent stroke or incidence of cardiovascular events (CV) after stroke. CI = confidence interval. *Adjusted for demographics, traditional risk factors, stroke severity, and both markers. (Adapted from Arch Intern Med.¹⁵)

Expression of lipoprotein-associated phospholipase A₂ (Lp-PLA₂) in atherosclerotic carotid plaques. Tissue staining of carotid atherosclerotic plaques for Lp-PLA₂ in 2 different studies has shown that rupture-prone, thin fibrous cap lesions exhibit intense staining for the biomarker. Advanced carotid atheromas are similar to advanced coronary atheromas in this respect. (illustration by Scott Barrows, medical illustrator, University of Illinois at Chicago.)