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(Circulation. 1999;100:1280-1284.)
© 1999 American Heart Association, Inc.

Clinical Investigation and Reports

Circulating Levels of Secretory Type II Phospholipase A₂ Predict Coronary Events in Patients with Coronary Artery Disease

Kiyotaka Kugiyama, MD; Yasutaka Ota, MD; Keiji Takazoe, MD; Yasushi Moriyama, MD; Hiroaki Kawano, MD; Yuji Miyao, MD; Tomohiro Sakamoto, MD; Hirofumi Soejima, MD; Hisao Ogawa, MD; Hideki Doi, MD; Seigo Sugiyama, MD; Hirofumi Yasue, MD

From the Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Kumamoto, Japan.

Correspondence to Kiyotaka Kugiyama, MD, PhD, Department of Cardiovascular Medicine, Kumamoto University School of Medicine, Honjo 1-1-1, Kumamoto City, Japan 860-8556. E-mail kiyo{at}gpo.kumamoto-u.ac.jp

Background—The circulating levels of secretory nonpancreatic type II phospholipase A₂ (sPLA₂) are increased in various chronic inflammatory diseases and the increase in the levels correlates with the disease severity. sPLA₂ may possibly play a role in atherogenesis and is highly expressed in atherosclerotic arterial walls that are known to have inflammatory features. Thus, this study prospectively examined whether circulating levels of sPLA₂ may have a significant risk and prognostic values in patients with coronary artery disease (CAD).

Methods and Results—Plasma levels of sPLA₂ were measured in 142 patients with CAD and in 93 control subjects by a radioimmunoassay. The sPLA₂ levels had a significant and positive relations with serum levels of C-reactive protein, a marker of systemic inflammation, and with the number of the traditional coronary risk factors associated with individuals. Multivariate logistic regression analysis showed that higher levels of sPLA₂ (>246 ng/dL; 75th percentile of sPLA₂ distribution in controls) were a significant and independent risk factor for the presence of CAD. In multivariate Cox hazard analysis, the higher levels of sPLA₂ were a significant predictor of developing coronary events (ie, coronary revascularization, myocardial infarction, coronary death) during a 2-year follow-up period in patients with CAD independent of other risk factors, including CRP levels, an established inflammatory predictor.

Conclusions—The increase in circulating levels of sPLA₂ is a significant risk factor for the presence of CAD and predicts clinical coronary events independent of other risk factors in patients with CAD; these results may reflect possible relation of sPLA₂ levels with inflammatory activity in atherosclerotic arteries.

Key Words: atherosclerosis • coronary disease • lipids • prognosis • risk factors

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