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McClellan S, Pitchaikannu A, Wright R, Bessert D, Iulianelli M, Hazlett LD, Xu S. Prophylactic Knockdown of the miR-183/96/182 Cluster Ameliorates Pseudomonas aeruginosa-Induced Keratitis. Invest Ophthalmol Vis Sci 2021; 62:14. [PMID: 34919120 PMCID: PMC8684302 DOI: 10.1167/iovs.62.15.14] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
Purpose Previously, we demonstrated that miR-183/96/182 cluster (miR-183C) knockout mice exhibit decreased severity of Pseudomonas aeruginosa (PA)-induced keratitis. This study tests the hypothesis that prophylactic knockdown of miR-183C ameliorates PA keratitis indicative of a therapeutic potential. Methods Eight-week-old miR-183C wild-type and C57BL/6J inbred mice were used. Locked nucleic acid-modified anti-miR-183C or negative control oligoribonucleotides with scrambled sequences (NC ORNs) were injected subconjunctivally 1 day before and then topically applied once daily for 5 days post-infection (dpi) (strain 19660). Corneal disease was graded at 1, 3, and 5 dpi. Corneas were harvested for RT-PCR, ELISA, immunofluorescence (IF), myeloperoxidase and plate count assays, and flow cytometry. Corneal nerve density was evaluated in flatmounted corneas by IF staining with anti-β-III tubulin antibody. Results Anti-miR-183C downregulated miR-183C in the cornea. It resulted in an increase in IL-1β at 1 dpi, which was decreased at 5 dpi; fewer polymorphonuclear leukocytes (PMNs) at 5 dpi; lower viable bacterial plate count at both 1 and 5 dpi; increased percentages of MHCII+ macrophages (Mϕ) and dendritic cells (DCs), consistent with enhanced activation/maturation; and decreased severity of PA keratitis. Anti-miR-183C treatment in the cornea of naïve mice resulted in a transient reduction of corneal nerve density, which was fully recovered one week after the last anti-miR application. miR-183C targets repulsive axon-guidance receptor molecule Neuropilin 1, which may mediate the effect of anti-miR-183C on corneal nerve regression. Conclusions Prophylactic miR-183C knockdown is protective against PA keratitis through its regulation of innate immunity, corneal innervation, and neuroimmune interactions.
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Affiliation(s)
- Sharon McClellan
- Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Ahalya Pitchaikannu
- Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Robert Wright
- Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Denise Bessert
- Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Mason Iulianelli
- Departments of Biological Sciences and Public Health, College of Liberal Arts and Sciences, Wayne State University, Detroit, Michigan, United States
| | - Linda D Hazlett
- Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, Michigan, United States
| | - Shunbin Xu
- Department of Ophthalmology, Visual and Anatomical Sciences, School of Medicine, Wayne State University, Detroit, Michigan, United States
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Kunadian V, Neely RDG, Sinclair H, Batty JA, Veerasamy M, Ford GA, Qiu W. Study to Improve Cardiovascular Outcomes in high-risk older patieNts (ICON1) with acute coronary syndrome: study design and protocol of a prospective observational study. BMJ Open 2016; 6:e012091. [PMID: 27554105 PMCID: PMC5013351 DOI: 10.1136/bmjopen-2016-012091] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
INTRODUCTION The ICON1 study (a study to Improve Cardiovascular Outcomes in high-risk older patieNts with acute coronary syndrome) is a prospective observational study of older patients (≥75 years old) with non-ST-elevation acute coronary syndrome managed by contemporary treatment (pharmacological and invasive). The aim of the study was to determine the predictors of poor cardiovascular outcomes in this age group and to generate a risk prediction tool. METHODS AND ANALYSIS Participants are recruited from 2 tertiary hospitals in the UK. Baseline evaluation includes frailty, comorbidity, cognition and quality-of-life measures, inflammatory status assessed by a biomarker panel, including microRNAs, senescence assessed by telomere length and telomerase activity, cardiovascular status assessed by arterial stiffness, endothelial function, carotid intima media thickness and left ventricular systolic and diastolic function, and coronary plaque assessed by virtual histology intravascular ultrasound and optical coherence tomography. The patients are followed-up at 30 days and at 1 year for primary outcome measures of death, myocardial infarction, stroke, unplanned revascularisation, bleeding and rehospitalisation. ETHICS AND DISSEMINATION The study has been approved by the regional ethics committee (REC 12/NE/016). Findings of the study will be presented in scientific sessions and will be published in peer-reviewed journals. TRIAL REGISTRATION NUMBER NCT01933581: Pre-results.
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Affiliation(s)
- Vijay Kunadian
- Institute of Cellular Medicine, Newcastle University,Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - R Dermot G Neely
- Department of Biochemistry, Newcastle upon Tyne Hospitals NHS Foundation Trust, Newcastle upon Tyne, UK
| | - Hannah Sinclair
- Institute of Cellular Medicine, Newcastle University,Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Jonathan A Batty
- Institute of Cellular Medicine, Newcastle University,Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Murugapathy Veerasamy
- Institute of Cellular Medicine, Newcastle University,Newcastle upon Tyne, UK
- Cardiothoracic Centre, Freeman Hospital, Newcastle upon Tyne, UK
| | - Gary A Ford
- Institute for Ageing and Health, Newcastle University, Newcastle upon Tyne, UK
| | - Weiliang Qiu
- Channing Division of Network Medicine, Brigham and Women's Hospital and Harvard Medical School, Boston, Massachusetts, USA
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Dong L, Qu X, Hu ZG, Peng X, Wang Y, Miao Q, Zhang X. Lipoprotein-associated Phospholipase A2 is Associated with Angiographic Coronary Artery Disease and Coronary Artery Risk Factors in the Elderly. INT J GERONTOL 2015. [DOI: 10.1016/j.ijge.2015.05.005] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022] Open
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Davidson JE, Lockhart A, Amos L, Stirnadel-Farrant HA, Mooser V, Sollberger M, Regeniter A, Monsch AU, Irizarry MC. Plasma lipoprotein-associated phospholipase A2 activity in Alzheimer's disease, amnestic mild cognitive impairment, and cognitively healthy elderly subjects: a cross-sectional study. ALZHEIMERS RESEARCH & THERAPY 2012; 4:51. [PMID: 23217243 PMCID: PMC3580460 DOI: 10.1186/alzrt154] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/07/2012] [Revised: 11/22/2012] [Accepted: 11/30/2012] [Indexed: 12/20/2022]
Abstract
Introduction Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a circulating enzyme with pro-inflammatory and oxidative activities associated with cardiovascular disease and ischemic stroke. While high plasma Lp-PLA2 activity was reported as a risk factor for dementia in the Rotterdam study, no association between Lp-PLA2 mass and dementia or Alzheimer's disease (AD) was detected in the Framingham study. The objectives of the current study were to explore the relationship of plasma Lp-PLA2 activity with cognitive diagnoses (AD, amnestic mild cognitive impairment (aMCI), and cognitively healthy subjects), cardiovascular markers, cerebrospinal fluid (CSF) markers of AD, and apolipoprotein E (APOE) genotype. Methods Subjects with mild AD (n = 78) and aMCI (n = 59) were recruited from the Memory Clinic, University Hospital, Basel, Switzerland; cognitively healthy subjects (n = 66) were recruited from the community. Subjects underwent standardised medical, neurological, neuropsychological, imaging, genetic, blood and CSF evaluation. Differences in Lp-PLA2 activity between the cognitive diagnosis groups were tested with ANOVA and in multiple linear regression models with adjustment for covariates. Associations between Lp-PLA2 and markers of cardiovascular disease and AD were explored with Spearman's correlation coefficients. Results There was no significant difference in plasma Lp-PLA2 activity between AD (197.1 (standard deviation, SD 38.4) nmol/min/ml) and controls (195.4 (SD 41.9)). Gender, statin use and low-density lipoprotein cholesterol (LDL) were independently associated with Lp-PLA2 activity in multiple regression models. Lp-PLA2 activity was correlated with LDL and inversely correlated with high-density lipoprotein (HDL). AD subjects with APOE-ε4 had higher Lp-PLA2 activity (207.9 (SD 41.2)) than AD subjects lacking APOE-ε4 (181.6 (SD 26.0), P = 0.003) although this was attenuated by adjustment for LDL (P = 0.09). No strong correlations were detected for Lp-PLA2 activity and CSF markers of AD. Conclusion Plasma Lp-PLA2 was not associated with a diagnosis of AD or aMCI in this cross-sectional study. The main clinical correlates of Lp-PLA2 activity in AD, aMCI and cognitively healthy subjects were variables associated with lipid metabolism.
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Affiliation(s)
- Julie E Davidson
- Worldwide Epidemiology, GlaxoSmithKline R&D, 1-3 Iron Bridge Road, Stockley Park, UB11 1BT, UK ; Memory Clinic, Department of Geriatrics, Basel University Hospital, Schanzenstrasse 55, 4031 Basel, Switzerland
| | - Andrew Lockhart
- R&D China, GlaxoSmithKline, Addenbrooke's Centre for Clinical Investigation, Addenbrooke's Hospital, Hills Road, Cambridge, CB2 2GG, UK
| | - Leslie Amos
- Genetics, GlaxoSmithKline R&D, 5 Moore Drive, Research Triangle Park, NC 27709, USA
| | | | - Vincent Mooser
- Genetics, GlaxoSmithKline R&D, 709 Swedeland Road, King of Prussia, PA 19406, USA
| | - Marc Sollberger
- Memory Clinic, Department of Geriatrics, Basel University Hospital, Schanzenstrasse 55, 4031 Basel, Switzerland
| | - Axel Regeniter
- Laboratory Medicine, Basel University Hospital, Basel, Switzerland
| | - Andreas U Monsch
- Memory Clinic, Department of Geriatrics, Basel University Hospital, Schanzenstrasse 55, 4031 Basel, Switzerland
| | - Michael C Irizarry
- Worldwide Epidemiology, GlaxoSmithKline R&D, 5 Moore Drive, Research Triangle Park, NC 27709, USA
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Ostadal P, Vondrakova D, Kruger A, Janotka M, Psotova H, Prucha M. Alteration in lipoprotein-associated phospholipase A2 levels during acute coronary syndrome and its relationship to standard biomarkers. Lipids Health Dis 2012; 11:153. [PMID: 23140470 PMCID: PMC3551646 DOI: 10.1186/1476-511x-11-153] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/22/2012] [Accepted: 11/06/2012] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Lipoprotein-associated phospholipase A2 (Lp-PLA2) probably plays an important role in the development of acute coronary syndrome (ACS); elevated levels of Lp-PLA2 are associated with a poorer prognosis in patients with ischemic heart disease. Alterations of Lp-PLA2 levels during ACS and its relationship to standard biomarkers are, however, unclear. FINDINGS Fifty-one consecutive ACS patients were enrolled in the study. All were managed with early invasive strategy and according to the current guidelines for pharmacotherapy; intensive statin therapy was started in all patients at admission. Serum levels of Lp-PLA2, LDL-cholesterol (LDL), troponin l (Tnl), and C-reactive protein (CRP) were assessed at admission (D0), on the first morning (D1), and on the second morning of hospitalization (D2). Mean serum levels of Lp-PLA2 (ng/mL) decreased from 264.6±19.1 at D0, to 193.2±14.4 at D1 (P < 0.001 vs. D0) and 189.8±22.6 at D2 (P = 0.002 vs. D0; P = not significant vs. D1). Alterations in Lp-PLA2 levels significantly correlated with changes in LDL (r = 0.43; P = 0.008). On the other hand, no relationship between Lp-PLA2 and Tnl or CRP was found. CONCLUSIONS Initially, serum levels of Lp-PLA2 were significantly elevated in ACS patients, but decreased within the first 24 hours after admission and subsequently remained stable. Lp-PLA2 levels correlated with LDL levels but not with Tnl or CRP levels. Our results demonstrated dynamic alterations in Lp-PLA2 levels during the early stages of ACS and, therefore, indirectly support the hypothesis of an active role for Lp-PLA2 in the pathogenesis of ACS.
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Affiliation(s)
- Petr Ostadal
- Department of Cardiology, Heart Center, Na Homolce Hospital, Roentgenova 2, 15030 Prague, Czech Republic.
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Dohi T, Miyauchi K, Ohkawa R, Nakamura K, Thuboi S, Ogita M, Miyazaki T, Nishino A, Yokoyama K, Kurata T, Yatomi Y, Daida H. Higher lipoprotein-associated phospholipase A2 levels are associated with coronary atherosclerosis documented by coronary angiography. Ann Clin Biochem 2012; 49:527-33. [PMID: 22933444 DOI: 10.1258/acb.2012.011252] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
BACKGROUND Lipoprotein-associated phospholipase A2 (Lp-PLA2) has been proposed as an inflammatory marker of cardiovascular disease. The present study investigates associations between Lp-PLA2 and other important biomarkers in Japanese patients with coronary artery disease. METHODS We measured Lp-PLA2 levels in 141 consecutive patients (age 62.6 ± 3.8 years; men 69.2%) with angiographic evidence of coronary artery disease (acute coronary syndrome [ACS]; n = 38), stable angina pectoris (SAP; n = 72) or with angiographically normal coronary arteries (NCA; n = 31). RESULTS Levels of Lp-PLA2 significantly correlated with low-density lipoprotein-cholesterol (r = 0.302), homocysteine (r = 0.528) and paraoxonase (r = 0.401) in all patients (all P < 0.01). Levels of Lp-PLA2 were significantly higher in patients with coronary atherosclerosis (ACS and SAP) than with NCA (P < 0.05). Levels of highly sensitive C-reactive protein were significantly higher in patients with ACS than with SAP and NCA (both P < 0.05). Multivariate logistic regression analyses revealed that higher Lp-PLA2 levels were independently associated with coronary atherosclerosis (odds ratio: 1.058; 95% confidence interval: 1.012-1.121; P = 0.001). CONCLUSIONS Higher Lp-PLA2 levels are associated with coronary atherosclerosis independently of traditional coronary risk factors. Thus, Lp-PLA2 is a novel biomarker of coronary atherosclerosis in Japanese patients.
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Affiliation(s)
- Tomotaka Dohi
- Department of Cardiovascular Medicine, Juntendo University School of Medicine, 2-1-1 Hongo, Tokyo 113-0033, Japan.
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Abstract
Although an atherogenic lipoprotein phenotype has been well recognized as an important predictor of cardiovascular disease, recent studies have demonstrated a number of additional lipid-related markers as emerging biomarkers to identify patients at risk for future coronary heart disease. Among them, lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), seems to be a promising candidate that might be added to the clinical armamentarium for improved prediction of cardiovascular disease in the future. Of particular note, Lp-PLA(2) is the only enzyme that cleaves oxidized low-density lipoprotein (oxLDL) in the subendothelial space, with further generation of proinflammatory mediators such as lysophosphatidylcholine (LysoPC) and oxidized fatty acid (oxFA), thereby probably linking two important features of atherogenesis, namely oxidation of LDL and local inflammatory processes within the atherosclerotic plaque. This overview aims to summarize our current knowledge based on observations from recent experimental and clinical studies. Emphasis has been put on potential pathophysiological mechanisms of action and on the clinical relevance of Lp-PLA(2) in a wide variety of clinical settings, including apparently healthy individuals, patients with stable angina or acute coronary syndromes, after myocardial infarction, and with subclinical disease. Although a growing body of evidence from epidemiological and clinical studies suggests that Lp-PLA(2) may represent an independent and clinically relevant long-term risk marker for coronary heart disease and, probably, also for stroke, the role of this enzyme in the setting of the acute coronary syndrome remains to be established.
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Affiliation(s)
- Natalie Khuseyinova
- Department of Internal Medicine II - Cardiology, University of Ulm Medical Center, Ulm, Germany
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Tzoulaki I, Siontis KCM, Ioannidis JPA. Prognostic effect size of cardiovascular biomarkers in datasets from observational studies versus randomised trials: meta-epidemiology study. BMJ 2011; 343:d6829. [PMID: 22065657 PMCID: PMC3209745 DOI: 10.1136/bmj.d6829] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 09/22/2011] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To compare the reported effect sizes of cardiovascular biomarkers in datasets from observational studies with those in datasets from randomised controlled trials. DESIGN Review of meta-analyses. STUDY SELECTION Meta-analyses of emerging cardiovascular biomarkers (not part of the Framingham risk score) that included datasets from at least one observational study and at least one randomised controlled trial were identified through Medline (last update, January 2011). DATA EXTRACTION Study-specific risk ratios were extracted from all identified meta-analyses and synthesised with random effects for (a) all studies, and (b) separately for observational and for randomised controlled trial populations for comparison. RESULTS 31 eligible meta-analyses were identified. For seven major biomarkers (C reactive protein, non-HDL cholesterol, lipoprotein(a), post-load glucose, fibrinogen, B-type natriuretic peptide, and troponins), the prognostic effect was significantly stronger in datasets from observational studies than in datasets from randomised controlled trials. For five of the biomarkers the effect was less than half as strong in the randomised controlled trial datasets. Across all 31 meta-analyses, on average datasets from observational studies suggested larger prognostic effects than those from randomised controlled trials; from a random effects meta-analysis, the estimated average difference in the effect size was 24% (95% CI 7% to 40%) of the overall biomarker effect. CONCLUSIONS Cardiovascular biomarkers often have less promising results in the evidence derived from randomised controlled trials than from observational studies.
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Affiliation(s)
- Ioanna Tzoulaki
- Department of Hygiene and Epidemiology, University of Ioannina School of Medicine, Ioannina, Greece
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK, Smith SC, Anderson JL, Albert N, Buller CE, Creager MA, Ettinger SM, Guyton RA, Halperin JL, Hochman JS, Kushner FG, Nishimura R, Ohman EM, Page RL, Stevenson WG, Tarkington LG, Yancy CW. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 56:e50-103. [PMID: 21144964 DOI: 10.1016/j.jacc.2010.09.001] [Citation(s) in RCA: 1001] [Impact Index Per Article: 77.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK. 2010 ACCF/AHA Guideline for Assessment of Cardiovascular Risk in Asymptomatic Adults: Executive Summary. J Am Coll Cardiol 2010. [DOI: 10.1016/j.jacc.2010.09.002] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010; 122:2748-64. [PMID: 21098427 DOI: 10.1161/cir.0b013e3182051bab] [Citation(s) in RCA: 259] [Impact Index Per Article: 18.5] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
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Greenland P, Alpert JS, Beller GA, Benjamin EJ, Budoff MJ, Fayad ZA, Foster E, Hlatky MA, Hodgson JM, Kushner FG, Lauer MS, Shaw LJ, Smith SC, Taylor AJ, Weintraub WS, Wenger NK, Jacobs AK. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2010; 122:e584-636. [PMID: 21098428 DOI: 10.1161/cir.0b013e3182051b4c] [Citation(s) in RCA: 402] [Impact Index Per Article: 28.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Suckling K. Phospholipase A2s: Developing drug targets for atherosclerosis. Atherosclerosis 2010; 212:357-66. [DOI: 10.1016/j.atherosclerosis.2010.03.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Revised: 03/08/2010] [Accepted: 03/08/2010] [Indexed: 12/24/2022]
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Lipoprotein-associated phospholipase A2 as a biomarker of coronary heart disease and a therapeutic target. Curr Opin Cardiol 2010; 24:358-63. [PMID: 19417639 DOI: 10.1097/hco.0b013e32832bcb22] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
PURPOSE OF REVIEW Lipoprotein-associated phospholipase A2 (Lp PLA2) is postulated to occupy a key position in the pathogenic sequence leading to formation of complex atherosclerotic lesions. This study reviews evidence supporting its role as a biomarker of vascular disease and as a possible therapeutic target. RECENT FINDINGS Evidence continues to build supporting the usefulness of Lp PLA2 as a predictor of coronary events in the general population and in those with established coronary heart disease. Elevated Lp PLA2 is also associated with stroke and heart failure. The crystal structure of Lp PLA2 is now available and offers insight into the links between structure, function and atherogenic properties. Recently completed studies on the efficacy of darapladib, a specific Lp PLA2 inhibitor, show beneficial changes in plaque morphology in animal models and in humans. SUMMARY Lp PLA2 is gaining acceptance as a useful biomarker of chronic inflammation and as a predictor of vascular disease. Early results with darapladib offer promise, but not definitive proof, of a potential role for Lp PLA2 inhibition in coronary heart disease prevention.
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Anuurad E, Ozturk Z, Enkhmaa B, Pearson TA, Berglund L. Association of lipoprotein-associated phospholipase A2 with coronary artery disease in African-Americans and Caucasians. J Clin Endocrinol Metab 2010; 95:2376-83. [PMID: 20194707 PMCID: PMC2869550 DOI: 10.1210/jc.2009-2498] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2009] [Accepted: 02/04/2010] [Indexed: 01/28/2023]
Abstract
CONTEXT Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is bound predominately to low-density lipoprotein and has been implicated as a risk factor for coronary artery disease (CAD). OBJECTIVE We investigated the association between Lp-PLA(2) and CAD in a biethnic African-American and Caucasian population. DESIGN Lp-PLA(2) mass, activity, and index, an integrated measure of mass and activity, and other cardiovascular risk factors were determined in 224 African-Americans and 336 Caucasians undergoing coronary angiography. MAIN OUTCOME MEASURES We assessed the distribution of Lp-PLA(2) levels and determined the predictive role of Lp-PLA(2) as a risk factor for CAD. RESULTS Levels of Lp-PLA(2) mass and activity were higher among Caucasians compared with African-Americans (293 +/- 75 vs. 232 +/- 76 ng/ml, P < 0.001 for mass and 173 +/- 41 vs. 141 +/- 39 nmol/min/ml, P < 0.001 for activity, respectively). However, Lp-PLA(2) index was similar in the two groups (0.61 +/- 0.17 vs. 0.64 +/- 0.19, P = NS). In both ethnic groups, Lp-PLA(2) activity and index was significantly higher among subjects with CAD. African-American subjects with CAD had significantly higher Lp-PLA(2) index than corresponding Caucasian subjects (0.69 +/- 0.20 vs. 0.63 +/- 0.18, P = 0.028). In multivariate regression analyses, after adjusting for other risk factors, Lp-PLA(2) index was independently (odds ratio 6.7, P = 0.047) associated with CAD in African-Americans but not Caucasians. CONCLUSIONS Lp-PLA(2) activity and index was associated with presence of CAD among African-Americans and Caucasians undergoing coronary angiography. The findings suggest an independent impact of vascular inflammation among African-Americans as contributory to CAD risk and underscore the importance of Lp-PLA(2) as a cardiovascular risk factor.
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Affiliation(s)
- Erdembileg Anuurad
- Department of Medicine, University of California, Davis, California 95817, USA
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Lipoprotein-associated phospholipase A(2) and risk of coronary disease, stroke, and mortality: collaborative analysis of 32 prospective studies. Lancet 2010; 375:1536-44. [PMID: 20435228 PMCID: PMC2864403 DOI: 10.1016/s0140-6736(10)60319-4] [Citation(s) in RCA: 467] [Impact Index Per Article: 33.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)), an inflammatory enzyme expressed in atherosclerotic plaques, is a therapeutic target being assessed in trials of vascular disease prevention. We investigated associations of circulating Lp-PLA(2) mass and activity with risk of coronary heart disease, stroke, and mortality under different circumstances. METHODS With use of individual records from 79 036 participants in 32 prospective studies (yielding 17 722 incident fatal or non-fatal outcomes during 474 976 person-years at risk), we did a meta-analysis of within-study regressions to calculate risk ratios (RRs) per 1 SD higher value of Lp-PLA(2) or other risk factor. The primary outcome was coronary heart disease. FINDINGS Lp-PLA(2) activity and mass were associated with each other (r=0.51, 95% CI 0.47-0.56) and proatherogenic lipids. We noted roughly log-linear associations of Lp-PLA(2) activity and mass with risk of coronary heart disease and vascular death. RRs, adjusted for conventional risk factors, were: 1.10 (95% CI 1.05-1.16) with Lp-PLA(2) activity and 1.11 (1.07-1.16) with Lp-PLA(2) mass for coronary heart disease; 1.08 (0.97-1.20) and 1.14 (1.02-1.27) for ischaemic stroke; 1.16 (1.09-1.24) and 1.13 (1.05-1.22) for vascular mortality; and 1.10 (1.04-1.17) and 1.10 (1.03-1.18) for non-vascular mortality, respectively. RRs with Lp-PLA(2) did not differ significantly in people with and without initial stable vascular disease, apart from for vascular death with Lp-PLA(2) mass. Adjusted RRs for coronary heart disease were 1.10 (1.02-1.18) with non-HDL cholesterol and 1.10 (1.00-1.21) with systolic blood pressure. INTERPRETATION Lp-PLA(2) activity and mass each show continuous associations with risk of coronary heart disease, similar in magnitude to that with non-HDL cholesterol or systolic blood pressure in this population. Associations of Lp-PLA(2) mass and activity are not exclusive to vascular outcomes, and the vascular associations depend at least partly on lipids. FUNDING UK Medical Research Council, GlaxoSmithKline, and British Heart Foundation.
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Affiliation(s)
- The Lp-PLA2 Studies Collaboration
- Correspondence to: Lp-PLA2 Studies Collaboration Coordinating Centre, Department of Public Health and Primary Care, University of Cambridge, Strangeways Research Laboratory, Cambridge CB1 8RN, UK
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Enkhmaa B, Anuurad E, Zhang W, Pearson TA, Berglund L. Association of Lp-PLA(2) activity with allele-specific Lp(a) levels in a bi-ethnic population. Atherosclerosis 2010; 211:526-30. [PMID: 20444451 DOI: 10.1016/j.atherosclerosis.2010.03.021] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2009] [Revised: 02/24/2010] [Accepted: 03/10/2010] [Indexed: 11/19/2022]
Abstract
OBJECTIVES Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and lipoprotein(a) [Lp(a)] have been implicated as cardiovascular disease risk factors, and are differentially regulated across ethnicity. We investigated the association between Lp-PLA(2) activity and allele-specific apolipoprotein(a) [apo(a)] levels in a bi-ethnic population. METHODS Lp-PLA(2) activity, Lp(a) and allele-specific apo(a) levels were determined in 224 African Americans and 336 Caucasians. RESULTS Lp-PLA(2) activity level was higher among Caucasians compared to African Americans (173 + or - 41 nmol/min/ml vs. 141 + or - 39 nmol/min/ml, P<0.001), and positively associated with Lp(a), total and LDL cholesterol, triglyceride, apolipoprotein B-100, and negatively with HDL cholesterol levels in both ethnic groups. The association between Lp-PLA(2) activity and Lp(a) was stronger among African Americans compared to Caucasians (R=0.238, beta(1)=3.48, vs. R=0.111, beta(1)=1.93, respectively). The Lp-PLA(2) activity level was significantly associated with allele-specific apo(a) levels for smaller (<26 K4 repeats) apo(a) sizes in both ethnic groups (P=0.015 for African Americans, P=0.038 for Caucasians). In contrast, for larger (>26 K4 repeats) apo(a) sizes, high Lp-PLA(2) activity levels were associated with higher allele-specific apo(a) levels in African Americans (P=0.009), but not in Caucasians. CONCLUSION The association between Lp-PLA(2) activity and allele-specific apo(a) levels differs across African American-Caucasian ethnicity.
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Affiliation(s)
- Byambaa Enkhmaa
- Department of Medicine, University of California, Davis, CA, USA
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Suckling KE. Phospholipase A2 inhibitors in the treatment of atherosclerosis: a new approach moves forward in the clinic. Expert Opin Investig Drugs 2009; 18:1425-30. [PMID: 19691442 DOI: 10.1517/13543780903184583] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
Phase II results of the trials of two phospholipase A2 inhibitors which may be of value in the treatment of atherosclerosis and cardiovascular disease have been reported in the past year. Darapladib (GlaxoSmithKline) is an inhibitor of lipoprotein-associated phospholipase A2 and varespladib (Anthera) inhibits several forms of the secreted phospholipase A2s. Despite the apparent similarity of mechanism, which is also built into the compounds' names, the role of the two types of phospholipase in atherogenesis is very different. Evidence for this comes from a range of preclinical studies and from epidemiological data which are summarised here. These data provide a basis for the Phase II studies and support decisions to move into Phase III, a decision which in the case of darapladib has been made and studies commenced (STABILITY trial). For varespladib the FRANCIS-ACS trial in acute coronary syndrome patients is in progress.
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Lipoprotein-Associated Phospholipase A2 and C-Reactive Protein for Measurement of Inflammatory Risk: Independent or Complementary? CURRENT CARDIOVASCULAR RISK REPORTS 2009. [DOI: 10.1007/s12170-009-0073-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
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McCullough PA. Darapladib and atherosclerotic plaque: should lipoprotein-associated phospholipase A2 be a therapeutic target? Curr Atheroscler Rep 2009; 11:334-7. [PMID: 19664375 DOI: 10.1007/s11883-009-0050-6] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
There is great interest in developing a reliable measure of atherosclerotic disease activity that can serve as an index of response to antiatherosclerotic therapies. The epidemiologic relationship between lipid measures, most notably low-density lipoprotein cholesterol (LDL-C), and binary cardiovascular events has been confirmed in treatment trials reliably demonstrating a reduction in LDL-C translating into improved cardiovascular outcomes. Lipoprotein-associated phospholipase A2 (LpPLA2) is part of a family of lipases involved in the modification of lipids within the atheroma and may be a complimentary therapeutic target to the reduction of LDL-C in patients with advanced atherosclerosis. Darapladib is an orally available, specific inhibitor of LpPLA2 activity and has been shown to reduce lysophosphatidylcholine content and expression of multiple genes associated with macrophage and T-lymphocyte functioning, with considerable decrease in plaque and necrotic core area. Thus, this agent holds the hope of being a bona fide antiatherosclerotic therapy that can be gauged through blood measurement of LpPLA2 activity.
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Affiliation(s)
- Peter A McCullough
- Divisions of Cardiology, Nutrition and Preventive Medicine, William Beaumont Hospital, Beaumont Health Center, Royal Oak, MI 48073, USA.
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Jenny NS, Solomon C, Cushman M, Tracy RP, Nelson JJ, Psaty BM, Furberg CD. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and risk of cardiovascular disease in older adults: results from the Cardiovascular Health Study. Atherosclerosis 2009; 209:528-32. [PMID: 19804884 DOI: 10.1016/j.atherosclerosis.2009.09.021] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/13/2009] [Revised: 09/09/2009] [Accepted: 09/09/2009] [Indexed: 11/24/2022]
Abstract
OBJECTIVE To examine associations between lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) antigen level (mass) and enzymatic activity (activity) and cardiovascular disease (CVD) in older adults. METHODS We examined associations of Lp-PLA(2) mass and activity with incident myocardial infarction (MI; n=508), stroke (n=565) and CVD death (n=665) using Cox regressions adjusted for age, sex, ethnicity and CVD risk factors in 3949 older adults, aged > or =65 years at baseline, from the Cardiovascular Health Study (CHS). RESULTS Lp-PLA(2) was associated with incident CVD events in these older adults. Hazard ratios (95% confidence intervals) for highest versus lowest tertiles of Lp-PLA(2) mass were 1.49 (1.19-1.85) for MI, 1.21 (0.98-1.49) for stroke and 1.11 (0.92-1.33) for CVD death. The highest tertile of Lp-PLA(2) activity was associated with MI (1.36; 1.09-1.70) and CVD death (1.23; 1.02-1.50). Combined Lp-PLA(2) tertile 3 and CRP>3mg/l, compared to Lp-PLA(2) tertile 1 and CRP<1mg/l, was associated with MI (2.29; 1.49-3.52) for Lp-PLA(2) mass and MI (1.66; 1.10-2.51) and CVD death (1.57; 1.08-2.26) for activity. For MI, both mass and activity added excess risk to elevated CRP alone ( approximately 20% excess risk) and activity added excess risk for CVD death ( approximately 12%). CONCLUSION Lp-PLA(2) mass and activity were associated with incident CVD events in older adults in CHS. Lp-PLA(2) and CRP were independent and additive in prediction of events. While associations were modest, these results support further exploration of Lp-PLA(2) to identify older individuals at risk for CVD.
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Affiliation(s)
- Nancy Swords Jenny
- Department of Pathology, College of Medicine, University of Vermont, Burlington, 208 South Park Drive, Colchester, VT 05446, United States.
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Suzuki T, Solomon C, Jenny NS, Tracy R, Nelson JJ, Psaty BM, Furberg C, Cushman M. Lipoprotein-associated phospholipase A(2) and risk of congestive heart failure in older adults: the Cardiovascular Health Study. Circ Heart Fail 2009; 2:429-36. [PMID: 19808373 DOI: 10.1161/circheartfailure.108.839613] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
BACKGROUND Inflammation may be a causative factor in congestive heart failure (CHF). Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) is an inflammation marker associated with vascular risk. One previous study showed an association of Lp-PLA(2) activity with CHF risk, but there were only 94 CHF cases and Lp-PLA(2) antigen, which is available clinically in the United States, was not measured. METHODS AND RESULTS We measured baseline Lp-PLA(2) antigen and activity in 3991 men and women without baseline CHF or cardiovascular disease who were participating in the Cardiovascular Health Study, a prospective observational study of adults 65 years or older. Cox proportional hazards models adjusted for age, sex, clinic site, race, low-density and high-density lipoprotein cholesterol, body mass index, systolic and diastolic blood pressure, hypertension, smoking status, pack-years, and diabetes were used to calculate hazard ratios and 95% CIs for incident CHF. Further models adjusted for coronary disease events during follow-up and C-reactive protein. Eight hundred twenty-nine participants developed CHF during 12.1 years. Adjusted hazard ratios for CHF with Lp-PLA(2) in the fourth compared with the first quartile were 1.44 (95% CI, 1.16 to 1.79) for Lp-PLA(2) antigen and 1.06 (95% CI, 0.84 to 1.32) for activity. Adjustment for incident coronary disease attenuated the hazard ratio for Lp-PLA(2) antigen to 1.26 (95% CI, 1.02 to 1.57), adjustment for C-reactive protein had minimal impact. CONCLUSIONS Lp-PLA(2) antigen was associated with risk of future CHF in older people, independent of CHF and coronary risk factors, and partly mediated by coronary disease events. Further clinical and basic research is needed to better understand the role of Lp-PLA(2) in CHF.
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Affiliation(s)
- Takeki Suzuki
- Department of Medicine, University of Vermont College of Medicine, Burlington, VT, USA
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Tiwari A. Current and emerging paradigms in the therapeutic management of atherosclerosis. Expert Opin Ther Targets 2009; 12:1523-46. [PMID: 19007321 DOI: 10.1517/14728220802544061] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023]
Abstract
BACKGROUND The pathogenesis of atherosclerosis lies in abnormalities in lipoprotein metabolism leading to pathological interactions with vessel walls and the release of inflammatory components, which further aggravate the disease condition. OBJECTIVE To elucidate current and emerging trends in drug discovery towards the development of new entities regulating lipoprotein metabolism and inflammatory components to combat the progression of atherosclerosis. METHODS Research/review articles in the public domain and press releases were employed. RESULTS/CONCLUSION With the recent failure of torcetrapib and succinobucol, drug discovery and development efforts towards the treatment of atherosclerosis have received a big jolt and have been slowed down to a certain extent [corrected]. But this could be a starting point for several new mechanisms that are emerging to discover new drugs to combat the disease.
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Affiliation(s)
- Atul Tiwari
- Jubilant Biosys Ltd., CardioMetabolic Disorder Group, Drug Discovery Unit-Biology, #96, 2nd Stage, Industrial Suburb, Yeshwantpur, Bangalore-560022, Karnatka, India.
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Suckling K. What is the future for drug development in atherosclerosis and dyslipidaemia? Expert Opin Drug Discov 2008; 4:1-3. [DOI: 10.1517/17460440802623849] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
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Anderson JL, Horne BD, Kolek MJ, Muhlestein JB, Mower CP, Park JJ, May HT, Camp NJ, Carlquist JF. Genetic variation at the 9p21 locus predicts angiographic coronary artery disease prevalence but not extent and has clinical utility. Am Heart J 2008; 156:1155-1162.e2. [PMID: 19033013 DOI: 10.1016/j.ahj.2008.07.006] [Citation(s) in RCA: 53] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/13/2008] [Accepted: 07/10/2008] [Indexed: 01/01/2023]
Abstract
BACKGROUND Variants at the 9p21 locus have been associated with coronary heart disease, but their precise disease phenotype and utility for clinical risk assessment are uncertain. METHODS Consenting patients with early-onset angiographic coronary artery disease (CAD) (n = 1,011) were compared with matched subjects (n = 545) free of angiographic disease and with a random population sample (n = 565). Cases and controls were genotyped for 4 variants, and ORs for angio-CAD were determined. Findings were validated in a separate set of cases and controls (n = 1,452). RESULTS Alleles were highly correlated (r(2) > or = 0.9), and all predicted angio-CAD compared with both control groups. Genotype at rs2383206 (minor allele frequency 45.9%), the most predictive (P < .0001), was associated with an adjusted odds ratio for angio-CAD of 1.39 (95% CI, 1.05-1.85) for heterozygote and 1.73 (1.26-2.37) for homozygote risk-allele carriers and explained 21% of population attributable risk and was independent of traditional risk factors and myocardial infarction. For the comparison of combined cases versus combined control samples (N = 3,573), CAD was predicted by high-risk allele homozygosity at P = 9 x 10(-8). Despite this, extent of disease was not increased. Applied to patients with intermediate Framingham risk scores, 9p21 genotyping modified risk classification in 24%. CONCLUSIONS Variants at the 9p21 locus robustly predict angiographic CAD prevalence, independent of standard risk factors, but not CAD extent or myocardial infarction; provide pathophysiological insights; and may be clinically useful in refining coronary heart disease risk classification.
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Brilakis ES, Khera A, Saeed B, Banerjee S, McGuire DK, Murphy SA, de Lemos JA. Association of Lipoprotein-Associated Phospholipase A2 Mass and Activity with Coronary and Aortic Atherosclerosis: Findings from the Dallas Heart Study. Clin Chem 2008; 54:1975-81. [DOI: 10.1373/clinchem.2008.107359] [Citation(s) in RCA: 26] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Abstract
Background: Our aim was to characterize the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) with coronary and aortic atherosclerosis in a large population-based study.
Methods: Lp-PLA2 mass and activity were measured in 2171 subjects 30–65 years old participating in the Dallas Heart Study. We examined the association of Lp-PLA2 levels with 3 atherosclerosis phenotypes: coronary artery calcium (CAC) measured by electron-beam computed tomography and abdominal aortic plaque (AAP) and aortic wall thickness (AWT) measured by magnetic resonance imaging.
Results: CAC and AAP were detected in 21% and 40% of subjects, respectively, and mean AWT (SD) was 1.70 (0.32) mm. In univariable analyses, Lp-PLA2 mass (but not activity) was higher in both men (P = 0.04) and women (P = 0.02) with detectable CAC. Lp-PLA2 mass and activity were higher (P = 0.004 and P = 0.01, respectively) and AWT was greater (P < 0.001 and P = 0.02, respectively) in women with aortic atheroma, but not in men. After adjustment for traditional atherosclerosis risk factors and C-reactive protein concentrations, Lp-PLA2 mass and activity were not associated with AAP or AWT in either sex, but Lp-PLA2 mass remained modestly associated with detectable CAC only in men (odds ratio 1.20 per 1 standard deviation increase, 95% CI 1.01–1.42, P = 0.04).
Conclusions: Although Lp-PLA2 mass was independently associated with CAC in men, it was not associated with AAP or AWT in men or with any of the atherosclerosis phenotypes in women. These findings suggest that if Lp-PLA2 independently influences clinical events, it does so by promoting atherosclerotic plaque instability rather than by stimulating atherogenesis.
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Affiliation(s)
- Emmanouil S Brilakis
- The Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX
- Dallas VA Medical Center, Dallas, TX
| | - Amit Khera
- The Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX
| | - Bilal Saeed
- The Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX
- Dallas VA Medical Center, Dallas, TX
| | - Subhash Banerjee
- The Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX
- Dallas VA Medical Center, Dallas, TX
| | - Darren K McGuire
- The Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX
| | | | - James A de Lemos
- The Donald W. Reynolds Cardiovascular Clinical Research Center at the University of Texas Southwestern Medical Center, Dallas, TX
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Koenig W, Khuseyinova N. Lipoprotein-associated and secretory phospholipase A2 in cardiovascular disease: the epidemiological evidence. Cardiovasc Drugs Ther 2008; 23:85-92. [PMID: 18949547 DOI: 10.1007/s10557-008-6135-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/03/2008] [Accepted: 08/07/2008] [Indexed: 01/23/2023]
Abstract
INTRODUCTION Among other lipid related biomarkers, lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and type II secretory phospholipase A(2) (sPLA(2)) represent emerging candidates for refined assessment of future cardiovascular disease (CVD) risk. Indeed, emerging evidence from more than prospective 15 studies conducted since 2000, clearly demonstrate the prognostic ability of increased Lp-PLA(2) concentrations or elevated activity for risk of future coronary heart disease (CHD) and stroke. Moreover, Lp-PLA(2) might have similar predictive power for both, incident CHD in initially healthy subjects, as well as for recurrent events in those with clinically manifest atherosclerosis. DISCUSSION By contrast, to date, there are only few prospective studies that have investigated the relationship of sPLA(2) with future CVD risk. However, most of them show a positive association between increased mass or elevated activity and future atherosclerotic complications. Nonetheless, since inhibitors of Lp-PLA(2) and sPLA(2) have already been developed, these enzymes may be considered as novel therapeutic targets to treat residual risk in certain high risk patient groups. CONCLUSION This review summarizes the epidemiologic evidence on the association between increased mass or elevated activity of these two phospholipases and risk of CVD.
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Affiliation(s)
- Wolfgang Koenig
- Department of Internal Medicine II-Cardiology, University of Ulm Medical Center, Albert-Einstein Allee, 23, 89081, Ulm, Germany.
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Gerber Y, Dunlay SM, Jaffe AS, McConnell JP, Weston SA, Killian JM, Roger VL. Plasma lipoprotein-associated phospholipase A2 levels in heart failure: association with mortality in the community. Atherosclerosis 2008; 203:593-8. [PMID: 18789441 DOI: 10.1016/j.atherosclerosis.2008.07.035] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/23/2008] [Revised: 07/22/2008] [Accepted: 07/22/2008] [Indexed: 10/21/2022]
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 (P(interaction)=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, P(difference)=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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Affiliation(s)
- Yariv Gerber
- Department of Health Sciences Research, Mayo Clinic College of Medicine, Rochester, MN 55905, United States
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Use of biomarkers to develop treatment strategies for atherosclerosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 10:304-15. [DOI: 10.1007/s11936-008-0051-8] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Wassertheil-Smoller S, Kooperberg C, McGinn AP, Kaplan RC, Hsia J, Hendrix SL, Manson JE, Berger JS, Kuller LH, Allison MA, Baird AE. Lipoprotein-Associated Phospholipase A
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, Hormone Use, and the Risk of Ischemic Stroke in Postmenopausal Women. Hypertension 2008; 51:1115-22. [DOI: 10.1161/hypertensionaha.107.103721] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Affiliation(s)
- Sylvia Wassertheil-Smoller
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Charles Kooperberg
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Aileen P. McGinn
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Robert C. Kaplan
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Judith Hsia
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Susan L. Hendrix
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - JoAnn E. Manson
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Jeffrey S. Berger
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Lewis H. Kuller
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Matthew A. Allison
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
| | - Alison E. Baird
- From the Department of Epidemiology and Population Health (S.W-S., A.P.M., R.C.K.), Albert Einstein College of Medicine, Bronx, NY; Fred Hutchinson Cancer Research Center (C.K.), Seattle, Wash; AstraZeneca (J.H.), Wilmington, Del; Department of Obstetrics and Gynecology (S.L.H.), Wayne State University School of Medicine/Hutzel Women’s Hospital, Detroit, Mich; Division of Preventive Medicine (J.E.M.), Brigham & Women’s Hospital, Harvard Medical School, Boston, Mass; Department of Cardiovascular
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New approaches to the concept of primary prevention of atherosclerosis. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2008; 10:73-82. [DOI: 10.1007/s11936-008-0008-y] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022]
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