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(Circulation. 2004;109:837-842.)
© 2004 American Heart Association, Inc.
Clinical Investigation and Reports |
From the Section of Atherosclerosis and Lipoprotein Research, Department of Medicine, Baylor College of Medicine, and Center for Cardiovascular Disease Prevention, Methodist DeBakey Heart Center, Houston, Tex (C.M.B., R.C.H.); the Departments of Biostatistics (H.B.) and Epidemiology (G.H.), School of Public Health, the University of North Carolina at Chapel Hill; the Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Md (J.C., A.R.S.); and the Division of Epidemiology, School of Public Health, University of Minnesota, Minneapolis (A.R.F.).
Correspondence to Christie M. Ballantyne, Baylor College of Medicine, 6565 Fannin, M.S. A-601, Houston, TX 77030. E-mail cmb{at}bcm.tmc.edu
Received August 27, 2003; revision received November 18, 2003; accepted November 20, 2003.
Background Measuring C-reactive protein (CRP) has been recommended to identify patients at high risk for coronary heart disease (CHD) with low LDL cholesterol (LDL-C). Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a proinflammatory enzyme associated primarily with LDL.
Methods and Results In a prospective, case cohort study in 12 819 apparently healthy middle-aged men and women in the Atherosclerosis Risk in Communities study, the relation between Lp-PLA2, CRP, traditional risk factors, and risk for CHD events over a period of
6 years was examined in a proportional hazards model, stratified by LDL-C. Lp-PLA2 and CRP levels were higher in the 608 cases than the 740 noncases. Both Lp-PLA2 and CRP were associated with incident CHD after adjustment for age, sex, and race with a hazard ratio of 1.78 for the highest tertile of Lp-PLA2 and 2.53 for the highest category of CRP versus the lowest categories. Lp-PLA2 correlated positively with LDL-C (r=0.36) and negatively with HDL-C (r=-0.33) but not with CRP (r=-0.05). In a model adjusted for traditional risk factors including LDL-C, the association of Lp-PLA2 with CHD was attenuated and not statistically significant. For individuals with LDL-C below the median (130 mg/dL), Lp-PLA2 and CRP were both significantly and independently associated with CHD in fully adjusted models. For individuals with LDL-C <130 mg/dL, those with both Lp-PLA2 and CRP levels in the highest tertile were at the greatest risk for a CHD event.
Conclusions Lp-PLA2 and CRP may be complementary in identifying individuals at high CHD risk who have low LDL-C.
Key Words: Key Words: coronary disease epidemiology inflammation risk factors
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