Abstract 1131: The Prognostic Utility of Secretory Phospholipase A2 in Patients With Stable Coronary Artery Disease
Background: Secretory phospholipase A2 (sPLA2) is believed to be involved in atherogenesis. To date, few prospective studies have examined the utility of sPLA2 for risk stratification. We examined the prognostic utility of sPLA2 activity in a large population of patients with stable coronary artery disease (CAD), independent of established risk markers.
Methods: sPLA2 activity was measured at baseline in 3738 subjects in PEACE, a randomized trial of trandolapril vs placebo in stable CAD (median 4.8y follow up). Multivariable Cox regression (limited access dataset, NHLBI) was used to adjust for demographics, risk factors, apoB/apoA1, and medications.
Results: The incidence of CV death (CVD), MI, or stroke significantly increased across quartiles of sPLA2 (P trend <.001, Fig⇓). After multivariable adjustment, sPLA2 remained independently associated with an increased risk of CVD, MI or stroke (Q4:Q1 adj HR 1.56, 95% CI 1.13–2.15, P=.007, Fig⇓). sPLA2 activity was modestly correlated with high-sensitivity C-reactive protein (hs-CRP, r=.26), but not with lipoprotein-associated phospholipase A2 (LpPLA2, r=.03). Elevated levels of sPLA2 remained significantly associated with the risk of CVD, MI or stroke after inclusion of hs-CRP and Lp-PLA2 in the model (Q4:Q1 adj HR 1.49, 95% CI 1.08 –2.06, P=.016). In ROC analyses, sPLA2 was the only marker to significantly improve the area under the curve (P=.005), as compared with traditional predictors.
Conclusion: sPLA2 activity is independently associated with an increased risk of CVD, MI or stroke in patients with stable CAD. Further studies will be required to establish its clinical utility and potential role as a therapeutic target.