Plasma lipoprotein-associated phospholipase A2 levels in heart failure: Association with mortality in the community

Yariv Gerber, Shannon M Dunlay, Allan S Jaffe, Joseph P. McConnell, Susan A. Weston, Jill M. Killian, Veronique Lee Roger

Research output: Contribution to journalArticle

22 Citations (Scopus)

Abstract

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a useful inflammatory marker of cardiovascular risk, yet little is known of its prognostic role in heart failure (HF). We evaluated the association of Lp-PLA2 with mortality in subjects with HF and assessed its incremental value for risk discrimination over established risk factors and biomarkers. Methods: Residents of Olmsted County, MN, diagnosed with HF between September 2003 and April 2007 (n = 646, mean age 76 years, 51% women) were prospectively enrolled and followed-up. Plasma Lp-PLA2 levels were measured at baseline and evaluated along with known risk indicators. Results: Lp-PLA2 was positively associated with male gender and low-density lipoprotein cholesterol and inversely associated with statin use and diabetes. During follow-up (median 21 months), 213 deaths occurred. Elevated Lp-PLA2 was associated with an increased risk of mortality (hazard ratio (HR) = 1.57; 95% confidence interval (CI): 1.03-2.37; P = 0.035, per 1-unit increase in the log-transformed values). The relationship differed markedly by age (Pinteraction = 0.003), with a strong association in patients under 80 years (covariate-adjusted HR = 3.83; 95% CI: 1.93-7.61; P < 0.001) and none in older ones (covariate-adjusted HR = 0.82; 95% CI: 0.44-1.51; P = 0.55). For the younger subjects, an improvement in the model's discriminatory power was obtained by adding Lp-PLA2 to established risk indicators and biomarkers (area under the receiver operating characteristic curve, 0.709-0.744, Pdifference = 0.008). Conclusion: In this community-based cohort of patients with HF, Lp-PLA2 was strongly and independently associated with mortality and contributed incrementally to risk discrimination in patients under 80 years of age.

Original languageEnglish (US)
Pages (from-to)593-598
Number of pages6
JournalAtherosclerosis
Volume203
Issue number2
DOIs
StatePublished - Apr 2009

Fingerprint

1-Alkyl-2-acetylglycerophosphocholine Esterase
Heart Failure
Mortality
Confidence Intervals
Biomarkers
Hydroxymethylglutaryl-CoA Reductase Inhibitors
ROC Curve
LDL Cholesterol

Keywords

  • Age
  • Cardiovascular diseases
  • Epidemiology
  • Heart failure
  • Inflammation
  • Lipoprotein-associated phospholipase A2
  • Risk factors
  • Secondary prevention

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Plasma lipoprotein-associated phospholipase A2 levels in heart failure : Association with mortality in the community. / Gerber, Yariv; Dunlay, Shannon M; Jaffe, Allan S; McConnell, Joseph P.; Weston, Susan A.; Killian, Jill M.; Roger, Veronique Lee.

In: Atherosclerosis, Vol. 203, No. 2, 04.2009, p. 593-598.

Research output: Contribution to journalArticle

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abstract = "Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a useful inflammatory marker of cardiovascular risk, yet little is known of its prognostic role in heart failure (HF). We evaluated the association of Lp-PLA2 with mortality in subjects with HF and assessed its incremental value for risk discrimination over established risk factors and biomarkers. Methods: Residents of Olmsted County, MN, diagnosed with HF between September 2003 and April 2007 (n = 646, mean age 76 years, 51{\%} women) were prospectively enrolled and followed-up. Plasma Lp-PLA2 levels were measured at baseline and evaluated along with known risk indicators. Results: Lp-PLA2 was positively associated with male gender and low-density lipoprotein cholesterol and inversely associated with statin use and diabetes. During follow-up (median 21 months), 213 deaths occurred. Elevated Lp-PLA2 was associated with an increased risk of mortality (hazard ratio (HR) = 1.57; 95{\%} confidence interval (CI): 1.03-2.37; P = 0.035, per 1-unit increase in the log-transformed values). The relationship differed markedly by age (Pinteraction = 0.003), with a strong association in patients under 80 years (covariate-adjusted HR = 3.83; 95{\%} CI: 1.93-7.61; P < 0.001) and none in older ones (covariate-adjusted HR = 0.82; 95{\%} CI: 0.44-1.51; P = 0.55). For the younger subjects, an improvement in the model's discriminatory power was obtained by adding Lp-PLA2 to established risk indicators and biomarkers (area under the receiver operating characteristic curve, 0.709-0.744, Pdifference = 0.008). Conclusion: In this community-based cohort of patients with HF, Lp-PLA2 was strongly and independently associated with mortality and contributed incrementally to risk discrimination in patients under 80 years of age.",
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T1 - Plasma lipoprotein-associated phospholipase A2 levels in heart failure

T2 - Association with mortality in the community

AU - Gerber, Yariv

AU - Dunlay, Shannon M

AU - Jaffe, Allan S

AU - McConnell, Joseph P.

AU - Weston, Susan A.

AU - Killian, Jill M.

AU - Roger, Veronique Lee

PY - 2009/4

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N2 - Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a useful inflammatory marker of cardiovascular risk, yet little is known of its prognostic role in heart failure (HF). We evaluated the association of Lp-PLA2 with mortality in subjects with HF and assessed its incremental value for risk discrimination over established risk factors and biomarkers. Methods: Residents of Olmsted County, MN, diagnosed with HF between September 2003 and April 2007 (n = 646, mean age 76 years, 51% women) were prospectively enrolled and followed-up. Plasma Lp-PLA2 levels were measured at baseline and evaluated along with known risk indicators. Results: Lp-PLA2 was positively associated with male gender and low-density lipoprotein cholesterol and inversely associated with statin use and diabetes. During follow-up (median 21 months), 213 deaths occurred. Elevated Lp-PLA2 was associated with an increased risk of mortality (hazard ratio (HR) = 1.57; 95% confidence interval (CI): 1.03-2.37; P = 0.035, per 1-unit increase in the log-transformed values). The relationship differed markedly by age (Pinteraction = 0.003), with a strong association in patients under 80 years (covariate-adjusted HR = 3.83; 95% CI: 1.93-7.61; P < 0.001) and none in older ones (covariate-adjusted HR = 0.82; 95% CI: 0.44-1.51; P = 0.55). For the younger subjects, an improvement in the model's discriminatory power was obtained by adding Lp-PLA2 to established risk indicators and biomarkers (area under the receiver operating characteristic curve, 0.709-0.744, Pdifference = 0.008). Conclusion: In this community-based cohort of patients with HF, Lp-PLA2 was strongly and independently associated with mortality and contributed incrementally to risk discrimination in patients under 80 years of age.

AB - Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a useful inflammatory marker of cardiovascular risk, yet little is known of its prognostic role in heart failure (HF). We evaluated the association of Lp-PLA2 with mortality in subjects with HF and assessed its incremental value for risk discrimination over established risk factors and biomarkers. Methods: Residents of Olmsted County, MN, diagnosed with HF between September 2003 and April 2007 (n = 646, mean age 76 years, 51% women) were prospectively enrolled and followed-up. Plasma Lp-PLA2 levels were measured at baseline and evaluated along with known risk indicators. Results: Lp-PLA2 was positively associated with male gender and low-density lipoprotein cholesterol and inversely associated with statin use and diabetes. During follow-up (median 21 months), 213 deaths occurred. Elevated Lp-PLA2 was associated with an increased risk of mortality (hazard ratio (HR) = 1.57; 95% confidence interval (CI): 1.03-2.37; P = 0.035, per 1-unit increase in the log-transformed values). The relationship differed markedly by age (Pinteraction = 0.003), with a strong association in patients under 80 years (covariate-adjusted HR = 3.83; 95% CI: 1.93-7.61; P < 0.001) and none in older ones (covariate-adjusted HR = 0.82; 95% CI: 0.44-1.51; P = 0.55). For the younger subjects, an improvement in the model's discriminatory power was obtained by adding Lp-PLA2 to established risk indicators and biomarkers (area under the receiver operating characteristic curve, 0.709-0.744, Pdifference = 0.008). Conclusion: In this community-based cohort of patients with HF, Lp-PLA2 was strongly and independently associated with mortality and contributed incrementally to risk discrimination in patients under 80 years of age.

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KW - Epidemiology

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KW - Inflammation

KW - Lipoprotein-associated phospholipase A2

KW - Risk factors

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