Lipoprotein-associated phospholipase A2 predicts cardiovascular events in dialyzed patients

Correlation of LP-PLA2 and MMP-9 with the occurrence of early neurological deterioration in patients with acute ischemic stroke

Early neurological deterioration is a common complication of acute ischemic stroke (AIS), which aggravates symptoms, worsens the condition, and counteracts the benefits of clinical treatment. The aim of this paper was to analyze the correlation between lipoprotein-associated phospholipase A2 (Lp-PLA2), matrix metalloproteinase-9 (MMP-9), and the occurrence of early neurological deterioration (END) in patients with AIS and to explore the clinical prediction of END by the combination of the 2 assays for the clinical prediction of END. A total of 500 AIS patients admitted to our hospital from October 2022 to October 2023 were included as study subjects, and the clinical data of all AIS patients were collected and organized to detect the levels of Lp-PLA2 and MMP-9. Categorized into END and non-END groups according to whether END occurred within 7 days of the onset of AIS, and comparing the clinical baseline data and laboratory index levels of the 2 groups. Logistic regression analysis was performed to determine the independent predictors of END, and the predictive effects of Lp-PLA2 and MMP-9 levels on END were assessed by subject work characteristics (ROC) curves. END occurred in 111 (22.2%) of 500 AIS patients. Multivariate logistic regression analysis showed that diabetes (OR 2.717, 95% CI:1.53-4.81, P < .001), baseline NIHSS score (OR 1.65, 95% CI:1.41-1.94, P < .001), Lp-PLA2 (OR 1.07, 95% CI:1.05-1.09, P < .001) and MMP-9 (OR 1.12, 95% CI:1.09-1.16, P < .001) levels were independent influences on the occurrence of END in patients with AIS after correcting for confounders. ROC curve analysis showed that Lp-PLA2, MMP-9, and a combination of both predicted END with an area under the curve was 0.730, 0.763, and 0.831, respectively, and the area under the curve for the combination of both predicting END was significantly higher than that for any of the inflammatory markers alone (P < .05). Both inflammatory markers, Lp-PLA2 and MMP-9, were independent predictors of the development of END in patients with AIS, and the combination of the two had a higher predictive value.

Lipoprotein-associated phospholipase A2 predicts cardiovascular death in patients on maintenance hemodialysis: a 7-year prospective cohort study

BACKGROUND

Cardiovascular diseases (CVD) is the leading cause of death among maintenance hemodialysis patients, with dyslipidemia being a prevalent complication. The paradoxical relationship between cardiovascular outcomes and established lipid risk markers, such as low-density lipoprotein cholesterol (LDL-C), complicates lipid management in this population. This study investigated Lipoprotein-associated phospholipase A2 (Lp-PLA2), an emerging biomarker known for its proinflammatory and proatherogenic properties, as a potential cardiovascular prognostic marker in this cohort. In this context, the association between Lp-PLA2 levels and cardiovascular outcomes was evaluated, with the aim to facilitate more accurate stratification and identification of high-risk individuals.

METHODS

From August 2013 to January 2014, 361 hemodialysis patients were prospectively enrolled. Lp-PLA2 activity and laboratory measures at baseline were quantified. Comorbidities and medications were recorded. All patients were followed until the end of April, 2022. The individual and combined effects of Lp-PLA2 activity and LDL-C on patient outcomes were examined. The association between Lp-PLA2 activity and all-cause mortality, cardiovascular mortality, and major adverse cardiovascular events (MACEs) was analyzed.

RESULTS

The median Lp-PLA2 activity was 481.2 U/L. In subjects with Lp-PLA2 activity over 481.2 U/L, significantly higher total cholesterol (4.89 vs. 3.98 mmol/L; P < 0.001), LDL-C (3.06 vs. 2.22 mmol/L; P < 0.001), and apolipoprotein B (0.95 vs. 0.75 mmol/L; P < 0.001) were observed. Over a median follow-up of 78.1 months, 182 patients died, with 77 cases identified as cardiovascular death, 88 MACEs happened. Cardiovascular mortality and MACEs, but not all-cause mortality, were significantly increased in the high Lp-PLA2 group. Cox regression analyses showed that high Lp-PLA2 activity was associated with cardiovascular mortality and MACE occurrence. After comprehensive adjustment, high Lp-PLA2 activity was independently associated with cardiovascular mortality(as a dichotomous variable: HR:2.57, 95%CI:1.58,4.18, P < 0.001; as a continuous variable: HR:1.25, 95%CI:1.10,1.41, P = 0.001) and MACEs(as a dichotomous variable: HR:2.17, 95%CI:1.39,3.40, P = 0.001; as a continuous variable: HR:1.20, 95%CI:1.07,1.36, P = 0.002). When participants were grouped by median Lp-PLA2 activity and LDL-C values, those with high Lp-PLA2 and low LDL-C had the highest CV mortality. The addition of Lp-PLA2 significantly improved reclassification (as a dichotomous variable NRI = 42.51%, 95%CI: 5.0%,61.33%; as a continuous variable, NRI = 33.32%, 95% CI: 7.47%,56.21%).

CONCLUSIONS

High Lp-PLA2 activity is an independent risk factor for cardiovascular mortality and MACEs occurrence in patients on hemodialysis. The combined measures of Lp-PLA2 and LDL-C help to identify individuals with a higher risk of cardiovascular death.

Lipoprotein-Associated Phospholipase A2 Correlates with Reduced Left Ventricle Ejection Fraction in Hemodialysis Patients

OBJECTIVE

Reduced left ventricular ejection fraction (LVEF) is common in hemodialysis (HD) patients. Lipoprotein-associated phospholipase A2 (Lp-PLA2) is considered an important determinant of cardiovascular events. The aim of the study was to evaluate the relationship between Lp-PLA2 and LVEF in HD patients.

METHODS

Fifty-seven HD patients with coronary heart disease were enrolled. Predialysis and postdialysis venous whole blood samples were collected. The patients were divided into preserved and reduced LVEF groups. The relationship between Lp-PLA2 and LVEF was assessed.

RESULTS

A significant difference in C-reactive protein (CRP) and Lp-PLA2 was observed, with higher levels noted in patients with reduced LVEF (P ≤ .001). Both Lp-PLA2 and CRP were negatively correlated with LVEF in the HD patients. Only Lp-PLA2 remained associated with LVEF in multiple regression analysis.

CONCLUSION

Lipoprotein-associated phospholipase A2 levels are associated with LVEF and could potentially be used to evaluate chronic heart failure with reduced LVEF in HD patients for risk stratification management.

Correlation of Blood Lipid and Serum Inflammatory Factor Levels With Hypertensive Disorder Complicating Pregnancy

Purpose

To explore the changes of blood lipid and serum inflammatory factors in pregnant women with hypertensive disorder complicating pregnancy (HDP) and the relationship with disease development.

Methods

107 pregnant women with HDP who had regular prenatal examination in our hospital from July 2018 to July 2021 were selected as the research objects. According to the severity of the disease, they were divided into gestational hypertension group, mild preeclampsia group and severe preeclampsia group. 30 healthy pregnant women who underwent prenatal examination in the same period were selected as the healthy group. Serum total cholesterol (TC), triglyceride (TG), high density lipoprotein cholesterol (HDL-C), low density lipoprotein cholesterol (LDL-C), lipoprotein-associated phospholipaseA2 (Lp-PLA2), C- reactive protein (CRP), interleukin -6 (IL-6), tumor necrosis factor-α (TNF-α) were measured. Receiver operating characteristic curve (ROC) was used to analyze the predictive value of blood lipid and serum inflammatory factors in pregnant women with HDP.

Results

The levels of serum TC, TG and LDL-C increased with the progression of HDP, the level of serum HDL-C decreased with the progression of HDP (P < 0.05). The levels of serum Lp-PLA2, CRP, IL-6 and TNF-α increased with the progression of HDP (P < 0.05). The AUC of serum TC, TG, HDL-C and LDL-C levels for predicting HDP were 0.759, 0.854, 0.770 and 0.785, respectively. The AUC of serum Lp-PLA2, CRP, IL-6 and TNF-α levels for predicting HDP were 0.873, 0.991, 0.966 and 0.999, respectively.

Conclusion

The levels of blood lipid and serum inflammatory factor are closely related to HDP, which has certain value in predicting the occurrence and development of HDP.

Serum IMA and LP-PLA2 Levels in Patients with Coronary Heart Disease and Their Correlation with the Degree of Myocardial Ischaemia and Their Diagnostic Value

Purpose

To measure serum levels of ischaemia-modified albumin (IMA) and lipoprotein-associated phospholipase A2 (LP-PLA2) in patients with coronary heart disease (CHD) and to analyse their correlation with the degree of myocardial ischaemia and their diagnostic value.

Methods

A sample of 150 patients diagnosed with CHD by coronary angiography in our hospital from March 2019 to September 2021 was taken as the CHD group. The patients were divided into acute myocardial infarction (AMI) group (n = 52), unstable angina pectoris (UAP) group (n = 54), and stable angina pectoris (SAP) group (n = 44) according to the degree of myocardial ischaemia, and then 50 healthy physical examination patients were selected as the health group during the same period. Serum C-reactive protein (CRP), interleukin-6 (IL-6), IMA, and LP-PLA2 levels were measured in each group separately. Multiple ordered logistic regression was used to analyse the factors influencing the degree of myocardial ischaemia in patients with CHD. Pearson correlation was used to analyse the correlation between serum IMA, LP-PLA2 levels and serum CRP, IL-6 levels in CHD patients. The diagnostic value of IMA alone, LP-PLA2 alone, and in combination for CHD was analysed using receiver operating characteristic (ROC) curves.

Results

In terms of serum CRP, IL-6, IMA, and LP-PLA2 levels, the CHD group was higher than the health group, the AMI and UAP groups were higher than the SAP and health groups, and the AMI group was higher than the UAP group (P < 0.05). Multiple ordered logistic regression analysis showed that serum CRP, IL-6, IMA, and LP-PLA2 levels were all independent influences on the degree of myocardial ischaemia in patients with CHD (P < 0.05). Pearson correlation analysis showed a positive correlation between serum IMA, LP-PLA2 levels and serum CRP, IL-6 levels in CHD patients (P < 0.001). The area under curve (AUC) for serum IMA levels to predict myocardial ischaemia in patients with CHD was 0.754 (95% CI: 0.684-0.825), with a sensitivity of 61.3% and specificity of 84.0% when the best cut-off value was 0.453; the AUC for serum LP-PLA2 levels to predict myocardial ischaemia in patients with CHD was 0.747 (95% CI: 0.681-0.813), with a sensitivity of 62.0% and specificity of 82.0% when the optimal cut-off value was 0.440; and the AUC of IMA + LP-PLA2 for predicting myocardial ischaemia in patients with CHD was 0.892 (95% CI: 0.847-0.938), with a sensitivity of 86.7% and specificity of 80.0% when the optimal cut-off value was 0.667. The specificity was 80.0%.

Conclusions

Serum IMA and LP-PLA2 levels are elevated in patients with CHD. Serum IMA and LP-PLA2 levels are closely related to the degree of myocardial ischaemia and its inflammatory level, and the combination of IMA + LP-PLA2 can improve the diagnosis efficacy of myocardial ischaemia in CHD patients.

Compliance, Adherence and Concordance Differently Predict the Improvement of Uremic and Microbial Toxins in Chronic Kidney Disease on Low Protein Diet

Background. In medicine, “compliance” indicates that the patient complies with the prescriber’s recommendations, “adherence” means that “the patient matches the recommendations” and “concordance” means “therapeutic alliance” between patient and clinician. While a low protein diet (LPD) is a cornerstone treatment of chronic kidney disease (CKD), monitoring the actual performance of LPD is a challenge. Patients. Fifty-seven advanced CKD adult patients were enrolled and LPD prescribed. Compliance was evaluated through the normalized protein catabolic rate (nPCR), adherence by the dietitian by means of a 24-h dietary recall and concordance by the nephrologist during consultations. Traditional parameters as well as total p-Cresyl Sulphate (t-PCS), total Indoxyl Sulphate (t-IS) and Lipoprotein-associated phspholipase A₂ (Lp-PLA₂) were compared between adherent/not adherent and concordant/not concordant subjects at enrolment and after two months. Results. nPCR, blood urea nitrogen, cholesterol and triglycerides significantly decreased in all patients. t-PCS and t-IS decreased among adherent subjects. Lp-PLA₂, t-PCS, free-PCS and t-IS decreased among concordant subjects, while these increased in non-concordant ones. Conclusion. This study demonstrates that LPD may improve the control of traditional uremic toxins and atherogenic toxins in “adherent” and “concordant” patients. A comprehensive and multidisciplinary approach is needed to evaluate the compliance/adherence/concordance to LPD for optimizing nutritional interventions.

Correlation between Serum LP-PLA2 and sST2 Levels and the Condition of Patients with Acute Heart Failure and Their Prognostic Value

Acute heart failure (AHF) occurs mostly in the elderly, which is a syndrome that occurs in the later stages of the development of cardiovascular disease. Due to the sharp decline in the patient's heart function, the patient has a high mortality rate and a poor prognosis, which seriously threaten the life safety of the elderly. Therefore, early diagnosis of AHF and timely treatment are extremely important. Lipoprotein-associated phospholipase A2 (LP-PLA2) is a newly discovered cardiovascular-specific inflammatory marker, which is closely related to the formation and progression of atherosclerotic plaque and the occurrence and development of coronary heart disease. Soluble growth stimulation expression gene 2 (sST2) protein is a protein produced under the induction of mechanical stress in cardiomyocytes. It can act as a decoy receptor to mediate the interleukin-33 (IL-33)/ST2 signaling pathway to bind to IL-33, thereby reducing the myocardial protective effect and leading to myocardial remodeling. The purpose of this study was to explore the serum LP-PLA2 and sST2 levels in AHF patients and to analyze their correlation with the disease and their prognostic value. The results showed that the levels of serum LP-PLA2 and sST2 were increased in AHF patients, and the levels of serum LP-PLA2 and sST2 in patients with adverse prognostic events were higher than those in patients without adverse prognostic events. The levels of serum LP-PLA2 and sST2 are closely related to the degree of patients' illness, among which the combined prediction of AHF patients with LP-PLA2 and sST2 has the highest value, which is worthy of promotion.

The changes of Lp-PLA2 in patients with gestational diabetes and its clinical significance

Gestational diabetes mellitus (GDM) is one of the most common complications of pregnancy and associated with adverse pregnancy outcomes. The aim of this study was to investigate the changes of lipoprotein-associated phospholipaseA2 (Lp-PLA2) level and its correlation with biochemical indexes in patients with GDM.This observational cross-sectional study was performed among 52 GDM and 48 healthy pregnant women. Automatic biochemical analyzer was employed to test the biochemical indexes, including fasting plasma glucose (FPG), Hemoglobin A1c (HbA1c), total cholesterol (TC), triglyceride (TG), high-density lipoprotein cholesterol (HDL-C) and low-density lipoprotein cholesterol (LDL-C). The lipoprotein-associated phospholipaseA2 (Lp-PLA2) level was evaluated by enzyme-linked immunosorbent assay, and homeostatic model assessment for insulin resistance (HOMA-IR) was calculated.The levels of FPG, HbA1c, HOMA-IR, TG, TC and LDL-C were significantly increased while high-density lipoprotein cholesterol (HDL-C) level was significantly decreased in the GDM group when compared with those in the control group. Lp-PLA2 level in maternal blood in the GDM group was significantly higher than that in the control group (199.125 ± 23.494 vs165.825 ± 15.576 ng/mL, P < .05) and logistic regression analysis further confirmed the association of Lp-PLA2 levels with GDM. Furthermore, Lp-PLA2 positively correlated with HOMA-IR, TC, and LDL-C.Our results confirmed the association of Lp-PLA2 with GDM. This broadens our knowledge on the pathophysiology of GDM and provides insights into the development of new targets for the prevention and treatment of GDM.

Relationship between Plasma Lipoprotein-Associated Phospholipase A2 Concentrations and Apolipoprotein in Stable Coronary Artery Disease Patients

Background

Increasing evidence states that the plasma lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and apolipoprotein particles are regarded as the risk maker for cardiovascular heart disease. Nevertheless, the issue about whether Lp-PLA2 is associated with apolipoprotein particles in individuals who have been diagnosed as stable coronary artery disease (CAD) remains largely unexplored.

Method

All 569 participants engaged in this research, who never took lipid-lowering drugs, had been divided into groups by the coronary angiography (CAG), namely, stable CAD: n = 291; non-CAD: n = 278. The results concerning Lp-PLA2 levels were calculated by Elisa Kit, while apolipoprotein particles were measured by the department of laboratory.

Results

The plasma concentration of Lp-PLA2 was remarkably higher in stable CAD group than the non-CAD group (136.0 ± 60.5 ng/mL vs. 113.2 ± 65.6 ng/mL, P < 0.001). Pearson correlation analyses explained the plasma Lp-PLA2 concentration was correlated with apoB (r = 0.390, P < 0.001) and apoB/apoA1 (r = 0.450, P < 0.001), not associated with apoA1 (r = −0.099, P = 0.101). Conversely, the association remains unobserved among non-CAD patients except apoA1. Moreover, multiple linear regression revealed the relations between Lp-PLA2 concentrations and apoB (β = 0.390, P < 0.001), as well as apoB/apoA1 (β = 0.450, P < 0.001), but not apoA1 (β = −0.099, P = 0.121). After adjustment for several risk factors regarding CAD, like hypertension, gender, smoking, age, and diabetes mellitus, there had still been positive associations between the Lp-PLA2 concentration and apoB (β = 0.364, P < 0.001), as well as apoB/apoA1 (β = 0.390, P < 0.001).

Conclusion

The plasma levels of Lp-PLA2 provide positively a key link with apoB, apoB/apoA-1 among stable CAD, denoting the communication between Lp-PLA2 and apolipoprotein particles in the state of CAD.

Lipoprotein-associated phospholipase A2 predicts lower limb ischemia in hemodialysis subjects

Hemodialyzed patients (HD) have high prevalence of peripheral arterial disease. In the general population, lipoprotein-associated phospholipase A2 (Lp-PLA² ) is associated with peripheral arterial disease but no data are available for renal subjects. The aim of this study was to evaluate the relationship between Lp-PLA₂ and lower limb ischemia among dialyzed patients. One hundred and two dialyzed subjects, with median (IQR) age of 71 (59-78) years, enrolled in June 2013 and followed until June 2018, were investigated for Lp-PLA₂ activity and the occurrence of peripheral arterial disease and lower limb ischemia. The median (IQR) levels of Lp-PLA₂ were 184 nmol/min/mL (156.5-214.5). The 43 HD patients with abnormal Lp-PLA₂ activity (>194 nmol/min/mL) had higher levels of total and LDL-cholesterol, ApoB/A1 ratio, and higher occurrence of lower limb ischemia during the follow up (44% vs 17%, P = .003). In multivariate analysis, Lp-PLA₂ activity (P = .018) and diabetes (P < .001) were independently associated with time to lower limb ischemia, and when the presence of previous PAD was added to the multivariate model, only presence of previous PAD (P < .001) and Lp-PLA₂ (P = .003) remained associated. Lp-PLA₂ is an independent predictor of lower limb ischemia in dialyzed patients.

Positron Emission Tomography Can Support the Diagnosis of Dialysis-Related Amyloidosis

BACKGROUND

The improvements in dialysis have not eliminated long-term problems, including dialysis-related amyloidosis (DRA), caused by Beta-2 microglobulin deposition. Several types of scintigraphy have been tested to detect DRA, none entered the clinical practice. Aim of the study was to assess the potential of PET-FDG scan in the diagnosis of DRA.

METHODS

Forty-six dialysis patients with at least one PET scan (72 scans) were selected out 162 patients treated in 2016-2018. Subjective global assessment (SGA), malnutrition inflammation score (A), Charlson Comorbidity Index (CCI), were assessed at time of scan; 218 age-matched cases with normal kidney function were selected as controls. PET scans were read in duplicate. Carpal tunnel syndrome was considered a proxy for DRA. A composite "amyloid score" score considered each dialysis year = 1 point; carpal tunnel-DRA = 5 points per site. Logistic regression, ROC curves and a prediction model were built.

RESULTS

The prevalence of positive PET was 43.5% in dialysis, 5% in controls (p < 0.0001). PET was positive in 14/15 (93.3%) scans in patients with carpal tunnel. PET sensitivity for detecting DRA was 95% (specificity 64%). Carpal tunnel was related to dialysis vintage and MIS. A positive PET scan was significantly associated with dialysis vintage, MIS and amyloid score. A prediction model to explain PET positivity combined clinical score and MIS, allowing for an AUC of 0.906 (CI: 0.813-0.962; p < 0.001).

CONCLUSIONS

PET-FDG may identify DRA, and may be useful in detecting cases in which inflammation favours B2M deposition. This finding, needing large-scale confirmation, could open new perspectives in the study of DRA.

Lp-PLA2 as a promising predictor of comorbidities in patients with severe psoriasis

Objective: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a well- known risk factor of atherosclerotic vascular diseases which are common comorbidities in psoriasis. The aim of this study was to evaluate serum Lp-PLA2 level in psoriatic patients and elucidate possible associations with disease activity, metabolic or inflammatory parameters and systemic treatment.Methods: We enrolled 33 patients with active plaque-type psoriasis and 11 healthy controls. Blood samples were collected before and after 3 months of systemic treatment with acitretin or methotrexate. Serum Lp-PLA2 level were evaluated by enzyme-linked immunosorbent assay.Results: Serum Lp-PLA2 level in patients with psoriasis did not statistically differ comparing to the control group (p = .2). However, in patients with severe psoriasis Lp-PLA2 was significantly higher than in the controls before and after treatment (p = .03, p = .01, respectively). The lipase did not correlate with BMI (p = .22); however, a statistical significance was noted between psoriatics with obesity compared to the controls (p = .03). No significant effect of systemic treatment combined (p = .5) nor separately with acitretin (p = .5) or methotrexate (p = .1) on the Lp-PLA2 level was found, despite clinical improvement.Conclusion: Lp-PLA2 assay might be helpful in assessment of the risk of cardiometabolic comorbidities development especially in patients with severe psoriasis and obesity.

Association between serum lipoprotein-associated phospholipase A2, ischemic modified albumin and acute coronary syndrome: a cross-sectional study

Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a newly emerging biomarker with strong pro-inflammatory effects, and is an independent risk predictor of atherosclerotic plaque rupture and thrombosis. In addition, ischemic modified albumin (IMA) is another important marker for the evaluation of myocardial ischemia, and has been approved by the U.S. Food and Drug Administration. The objective of this study was to investigate serum Lp-PLA2 and IMA in the early diagnosis, progression and prognosis of acute coronary syndrome (ACS). Serum Lp-PLA2 and IMA were detected using an AU5800 automatic biochemical analyzer in samples from 180 patients with ACS [n = 60 with unstable angina pectoris (UA), n = 56 with non-ST segment elevation myocardial infarction (NSTEMI), and n = 64 with ST segment elevation myocardial infarction (STEMI)] and 60 healthy control subjects. The relationship between Lp-PLA2 and IMA with Gensini score and the number of coronary artery lesions was explored, and logistic regression was conducted to identify risk factors for major adverse cardiovascular events (MACE). Serum Lp-PLA2 and IMA were significantly higher in all ACS subgroups compared to the control group (P < 0.05), were positively associated with the severity of ACS based on the Gensini score (P < 0.05), and were significantly higher in patients with double- and triple-vessel lesions compared to those with single-vessel lesions and healthy controls (P < 0.05). Logistic regression identified Lp-PLA2, IMA, and troponin I levels as independent risk factors for MACE. Lp-PLA2 and IMA were predictive of the degree of myocardial ischemia in patients with ACS, and may provide important clinical significance for the early diagnosis of ACS and the choice of treatment strategy.