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Cao Y, Yue X, Jia M, Wang J. Neuroinflammation and anti-inflammatory therapy for ischemic stroke. Heliyon 2023; 9:e17986. [PMID: 37519706 PMCID: PMC10372247 DOI: 10.1016/j.heliyon.2023.e17986] [Citation(s) in RCA: 10] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2022] [Revised: 04/25/2023] [Accepted: 07/04/2023] [Indexed: 08/01/2023] Open
Abstract
Stroke remains one of the most devastating and challenging neurological diseases worldwide. Inflammation, as well as oxidative stress is one of the main contributors to post-stroke injuries, and oxidative stress can further induce inflammation. Moreover, the inflammatory response is closely related to immune modulation in ischemic stroke progression. Hence, major ischemic stroke treatment strategies include targeting inflammatory responses, immune modulation (especially immune cells), and inflammatory response to suppress stroke progression. To date, several drugs have demonstrated clinical efficacy, such as Etanercept and Fingolimod. However, only edaravone dexborneol has successfully passed the phase III clinical trial and been approved by the National Medical Products Administration (NMPA) to treat ischemic stroke in China, which can restore redox balance and regulate inflammatory immune responses, thus providing neuroprotection in ischemic stroke. In this review, we will comprehensively summarize the current advances in the application of inflammatory biomarkers, neuroinflammation and neuro-immunotherapeutic scenarios for ischemic stroke, thus aiming to provide a theoretical basis and new prospects and frontiers for clinical applications.
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Affiliation(s)
- Yangyue Cao
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
| | - Xuanye Yue
- Department of Neurology, Tianjin Medical University General Hospital, Tianjin, China
| | - Meng Jia
- National Clinical Research Center for Neurological Diseases, Beijing Tiantan Hospital, Capital Medical University, Beijing, China
| | - Jiawei Wang
- Department of Neurology, Beijing Tongren Hospital, Capital Medical University, Beijing, China
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Al-Kuraishy HM, Hussien NR, Al-Naimi MS, Al-Gareeb AI, Lugnier C. Statins Therapy Improves Acute Ischemic Stroke in Patients with Cardio-metabolic Disorders Measured by Lipoprotein-Associated Phospholipase A2 (Lp-PLA2): New Focal Point. Neurol India 2021; 69:1637-1644. [PMID: 34979662 DOI: 10.4103/0028-3886.333482] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Acute ischemic stroke (AIS) leads to neuronal and endothelial damage that activate the release of proinflammatory mediators such as lipoprotein-associated phospholipase A2 (Lp-PLA2), which lead to the development of brain edema injury. Most of statins produce differential effects on Lp-PLA2 activity and mass with a comparable reduction in low-density lipoprotein (LDL) serum levels. AIMS The aim of this study is to evaluate the differential effect of different statins on the mass of level of Lp-PLA2 in patients with AIS. METHODS A total of 69 patients with AIS aged 40-70 years compared with matched 39 healthy controls were involved in this case-control study. The AIS patients were divided according to the statins therapy into 39 patients on statins therapy (statins on), and 30 patients were not on the statins therapy (statins off). Anthropometric variables including weight, height, body mass index (BMI), and blood pressure profile were estimated. Besides, biochemical variables including lipid profile[total cholesterol (TC), triglyceride (TG), LDL, very low-density lipoprotein (VLDL), high-density lipoprotein (HDL)], Lp-PLA2 mass levels, high-sensitive C-reactive protein (Hs-CRP) were estimated. RESULTS Patients with AIS had high Lp-PLA2 mass levels (P < 0.01) that positively correlated with high Hs-CRP, blood pressure, BMI, TC, TG, VLDL, LDL, and negatively correlated with HDL as compared with healthy controls. As well, statins on patients had lower Lp-PLA2 mass levels (9.82 ± 3.19 IU/mL) compared with statins off patients (16.55 ± 4.72 IU/mL), (P = 0.0001). Regarding the gender differences in the Lp-PLA2 mass level, it was higher in men patients with AIS compared with comparable females (P = 0.03). CONCLUSIONS Lp-PLA2 mass level was higher in patients with AIS and linked with underlying poor cardio-metabolic disorders. Therefore, the Lp-PLA2 mass level is observed to be a surrogate biomarker of AIS mainly in patients with poor cardio-metabolic disorders. Statin therapy improves the Lp-PLA2 mass level and the poor cardio-metabolic profile in patients with AIS.
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Affiliation(s)
- Hayder M Al-Kuraishy
- Department of Clinical Pharmacology and Therapeutic, Medical FacultyCollege of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
| | - Nawar R Hussien
- Department of Clinical Pharmacology and Therapeutic, Medical FacultyCollege of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
| | - Marwa S Al-Naimi
- Department of Clinical Pharmacology and Therapeutic, Medical FacultyCollege of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
| | - Ali I Al-Gareeb
- Department of Clinical Pharmacology and Therapeutic, Medical FacultyCollege of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
| | - Claire Lugnier
- Department of Clinical Pharmacology and Therapeutic, Medical FacultyCollege of Medicine, Al-Mustansiriyah University, Baghdad, Iraq
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Shen H, Wu D, Wang S, Zhao M, Sun W, Zhu X, Zhang N, Yao H, Cui Q, Xiao H. Atypical Antipsychotic Administration in Schizophrenic Patients Leads to Elevated Lipoprotein-Associated Phospholipase A2 Levels and Increased Cardiovascular Risk: A Retrospective Cohort Study. Basic Clin Pharmacol Toxicol 2018; 123:756-765. [PMID: 29938908 DOI: 10.1111/bcpt.13079] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2018] [Accepted: 06/13/2018] [Indexed: 12/31/2022]
Abstract
The prevalence of cardiovascular disease (CVD) is higher in patients with schizophrenia than in the general population. We aimed to investigate whether atypical antipsychotics (AAP) increase the levels of lipoprotein-associated phospholipase A2 (Lp-PLA2), thereby increasing the risk of CVD. The data were from inpatients aged 18-60 years with a diagnosis of schizophrenia according to ICD-10 at the Affiliated Brain Hospital of Nanjing Medical University who underwent physical examination between 1 October 2014 and 30 September 2016. A retrospective cohort study was used to analyse the correlation between AAP, Lp-PLA2 levels and the CVD risk (it was determined that Lp-PLA2 values >200 ng/mL were defined as high CVD risk) in patients treated with monotherapy, olanzapine, clozapine or quetiapine. Data were collected for 452 patients with eligible schizophrenia: 163 treated with clozapine, 186 treated with olanzapine, 47 treated with quetiapine and 56 receiving no medication. Compared with the no-medication patients, AAP administration in patients with olanzapine, clozapine or quetiapine had higher serum Lp-PLA2 levels when age, sex, BMI and fasting glucose level were matched. AAP were significantly associated with serum Lp-PLA2 level by Spearman's correlation coefficients. The results of logistic regression analysis showed that AAP administration was an independent factor of CVD risk when adjusted by potential confounding factors. This study is the first to confirm that AAP administration, especially clozapine and olanzapine, could increase Lp-PLA2 levels and CVD risk, independent of drug-induced weight gain in schizophrenia. The extent and the factors of increasing Lp-PLA2 level and CVD risk in olanzapine, clozapine and quetiapine are discrepant. The possible effects of AAP on Lp-PLA2 in schizophrenia patients are involved in pro-inflammatory cytokines and hormones.
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Affiliation(s)
- Hong Shen
- Neuro-Psychiatric Institute, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Danyang Wu
- Department of Pharmacy, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Shanshan Wang
- Department of Pharmacy, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Mengjie Zhao
- Neuro-Psychiatric Institute, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Wenbo Sun
- Neuro-Psychiatric Institute, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Xiaozhou Zhu
- Neuro-Psychiatric Institute, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Ning Zhang
- Department of Medical Psychology, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hui Yao
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Qing Cui
- Department of Psychiatry, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
| | - Hong Xiao
- Neuro-Psychiatric Institute, The Affiliated Brain Hospital of Nanjing Medical University, Nanjing, China
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The elevated lipoprotein-associated phospholipase A2 activity is associated with the occurrence and recurrence of acute cerebral infarction. Neuroreport 2018; 28:325-330. [PMID: 28272264 DOI: 10.1097/wnr.0000000000000765] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/06/2023]
Abstract
There is a strong association between lipoprotein-associated phospholipase A2 (Lp-PLA2) levels and atherosclerosis-related diseases. The aim of this study was to investigate the role of Lp-PLA2 in the ischemic stroke and further offer clinical evidence that measuring Lp-PLA2 helps predict the risk of stroke occurrence and recurrence. A total of 328 hospitalized patients were recruited, including 179 cases of acute cerebral infarction (ACI) and 149 non-ACI controls. The serum level of Lp-PLA2 in ACI was significantly higher than non-ACI. The serum level of Lp-PLA2 in the recurrence of ACI was significantly higher than the nonrecurrence. The serum levels of Lp-PLA2 in large-artery atherosclerosis subtype were the highest among the subtypes of the Trial of Org 10172 in Acute Stroke Treatment and non-ACI controls. The level of Lp-PLA2 in large-artery atherosclerosis and the cardioembolism group was statistically significantly higher than that of the control cases. There was no statistically significant difference between the small-vessel occlusion group and the control cases. The present study confirmed that the elevated Lp-PLA2 level can be a risk factor for ischemic stroke in the Chinese population. The serum level of Lp-PLA2 may be a predictive factor for the recurrence of ACI.
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Vijayan M, Reddy PH. Peripheral biomarkers of stroke: Focus on circulatory microRNAs. Biochim Biophys Acta Mol Basis Dis 2016; 1862:1984-93. [PMID: 27503360 DOI: 10.1016/j.bbadis.2016.08.003] [Citation(s) in RCA: 92] [Impact Index Per Article: 11.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/16/2016] [Revised: 08/02/2016] [Accepted: 08/04/2016] [Indexed: 12/12/2022]
Abstract
Stroke is the second leading cause of death in the world. Stroke occurs when blood flow stops, and that stoppage results in reduced oxygen supply to neurons in the brain. The occurrence of stroke increases with age, but anyone at any age can suffer from stroke. Recent research has implicated multiple cellular changes in stroke patients, including oxidative stress and mitochondrial dysfunction, inflammatory responses, and changes in mRNA and proteins. Recent research has also revealed that stroke is associated with modifiable and non-modifiable risk factors. Stroke can be controlled by modifiable risk factors, including diet, cardiovascular, hypertension, smoking, diabetes, obesity, metabolic syndrome, depression and traumatic brain injury. Stroke is the major risk factor for vascular dementia (VaD) and Alzheimer's disease (AD). The purpose of this article is to review the latest developments in research efforts directed at identifying 1) latest developments in identifying biomarkers in peripheral and central nervous system tissues, 2) changes in microRNAs (miRNAs) in patients with stroke, 3) miRNA profile and function in animal brain, and 4) protein biomarkers in ischemic stroke. This article also reviews research investigating circulatory miRNAs as peripheral biomarkers of stroke.
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Affiliation(s)
- Murali Vijayan
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, 3601 4th Street, MS 9424, Lubbock, TX 79430, United States
| | - P Hemachandra Reddy
- Garrison Institute on Aging, Texas Tech University Health Sciences Center, 3601 4th Street, MS 9424, Lubbock, TX 79430, United States; Cell Biology & Biochemistry, Texas Tech University Health Sciences Center, 3601 4th Street, MS 9424, Lubbock, TX 79430, United States; Neuroscience & Pharmacology, Texas Tech University Health Sciences Center, 3601 4th Street, MS 9424, Lubbock, TX 79430, United States; Neurology, Texas Tech University Health Sciences Center, 3601 4th Street, MS 9424, Lubbock, TX 79430, United States; Speech, Language and Hearing Sciences Departments, Texas Tech University Health Sciences Center, 3601 4th Street, MS 9424, Lubbock, TX 79430, United States; Garrison Institute on Aging, South West Campus, Texas Tech University Health Sciences Center, 6630 S. Quaker Ste. E, MS 7495, Lubbock, TX 79413, United States.
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Miklishanskaya SV, Vlasik TN, Kheimets GI, Kukharchuk VV. The possibility of reducing the Lp-PLA2 mass level using simvastatin monotherapy and combination therapy with ezetimibe. COR ET VASA 2015. [DOI: 10.1016/j.crvasa.2015.03.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
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Pop D, Dădârlat A, Zdrenghea D. Novel cardiovascular risk markers in women with ischaemic heart disease. Cardiovasc J Afr 2015; 25:137-41. [PMID: 25000444 PMCID: PMC4120125 DOI: 10.5830/cvja-2014-014] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 03/14/2014] [Indexed: 11/06/2022] Open
Abstract
Abstract The incidence of coronary heart disease in premenopausal women is lower than in men because of their hormonal protection. Angina pectoris occurs in women about 10 years later than in men. However, mortality from ischaemic heart disease remains higher in women than in men. Current studies are focusing on novel cardiovascular risk biomarkers because it seems that traditional cardiovascular risk factors and their assessment scores underestimate the risk in females. Increased plasma levels of these newly established biomarkers of risk have been found to worsen endothelial dysfunction and inflammation, both of which play a key role in the pathogenesis of microvascular angina, which is very common in women. These novel cardiovascular risk markers can be classified into three categories: inflammatory markers, markers of haemostasis, and other biomarkers.
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Affiliation(s)
- Dana Pop
- University of Medicine and Pharmacy Iuliu HaŢieganu, Cluj-Napoca, Romania.
| | - Alexandra Dădârlat
- University of Medicine and Pharmacy Iuliu HaŢieganu, Cluj-Napoca, Romania
| | - D Zdrenghea
- University of Medicine and Pharmacy Iuliu HaŢieganu, Cluj-Napoca, Romania
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Paik JK, Kim M, Kim M, Yen Y, Ahn HY, Lee SH, Lee JH. Circulating Lp-PLA₂ activity correlates with oxidative stress and cytokines in overweight/obese postmenopausal women not using hormone replacement therapy. AGE (DORDRECHT, NETHERLANDS) 2015; 37:32. [PMID: 25840804 PMCID: PMC4385327 DOI: 10.1007/s11357-015-9770-4] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/18/2014] [Accepted: 03/20/2015] [Indexed: 06/04/2023]
Abstract
Controversy remains regarding whether there is an association between circulating lipoprotein-associated phospholipase A2 (Lp-PLA2), cytokines, and oxidative stress in healthy postmenopausal women. We investigated the influence of age on Lp-PLA2 activity in postmenopausal women not using hormone therapy and the relationship of Lp-PLA2 enzyme activity to serum cytokine levels and oxidative stress indices. Normal weight (n = 1284) and overweight/obese (n = 707) postmenopausal women not using hormone therapy were categorized into five age groups: 50-54, 55-59, 60-64, 65-69, and 70-89 years. Overweight-obese women showed higher plasma Lp-PLA2 activity, urinary 8-epi-prostaglandin F2α (8-epi-PGF2α), serum interleukin (IL)-6, and smaller LDL particles than normal-weight women after adjusting for age, years postmenopause, smoking, drinking, blood pressure, glucose, insulin, lipid profiles, BMI, and waist circumference. Overweight/obese women 70-89 years old showed higher Lp-PLA2 activity than those aged 50-54 years, whereas no significant difference in Lp-PLA2 activity existed across normal-weight female age groups. Overweight/obese women aged ≥ 65 years showed higher Lp-PLA2, oxidized LDL (ox-LDL), IL-6, and 8-epi-PGF2α than age-matched normal-weight controls. Overweight/obese women aged ≥ 70 years had higher ox-LDL levels than those aged 50-59, and overweight/obese women aged 65-89 showed higher IL-6 and 8-epi-PGF2α. There were strong positive correlations between Lp-PLA2 and ox-LDL (r = 0.385, P < 0.001), Lp-PLA2 and IL-6 (r = 0.293, P < 0.001), and ox-LDL and IL-6 (r = 0.303, P < 0.001) in overweight/obese women; however, these relationships were weak in normal-weight women. These results suggest that aging and obesity-related oxidative and inflammatory mediators are associated with Lp-PLA2 activity in overweight/obese postmenopausal women not using hormone therapy.
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Affiliation(s)
- Jean Kyung Paik
- Department of Food and Nutrition, Eulji University, Gyeonggi-do, Republic of Korea
| | - Minkyung Kim
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, Republic of Korea
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, Republic of Korea
| | - Minjoo Kim
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, Republic of Korea
| | - Yuna Yen
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, Republic of Korea
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, Republic of Korea
| | - Hyeon Yeong Ahn
- Interdisciplinary Course of Science for Aging, Yonsei University, Seoul, Republic of Korea
| | - Sang-Hyun Lee
- Department of Family Practice, National Health Insurance Corporation, Ilsan Hospital, Goyang, Republic of Korea
| | - Jong Ho Lee
- National Leading Research Laboratory of Clinical Nutrigenetics/Nutrigenomics, Department of Food and Nutrition, College of Human Ecology, Yonsei University, Seoul, Republic of Korea
- Department of Food and Nutrition, Brain Korea 21 PLUS Project, College of Human Ecology, Yonsei University, Seoul, Republic of Korea
- Research Center for Silver Science, Institute of Symbiotic Life-TECH, Yonsei University, Seoul, Republic of Korea
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Ge J, Wang J, Xue D, Zhu Z, Chen Z, Li X, Su D, Du J. Why does a high-fat diet induce preeclampsia-like symptoms in pregnant rats. Neural Regen Res 2014; 8:1872-80. [PMID: 25206496 PMCID: PMC4145971 DOI: 10.3969/j.issn.1673-5374.2013.20.006] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2013] [Accepted: 06/06/2013] [Indexed: 12/22/2022] Open
Abstract
Changes in neurotransmitter levels in the brain play an important role in epilepsy-like attacks after pregnancy-induced preeclampsia-eclampsia. Metabotropic glutamate receptor 1 participates in the onset of lipid metabolism disorder-induced preeclampsia. Pregnant rats were fed with a high-fat diet for 20 days. Thus, these pregnant rats experienced preeclampsia-like syndromes such as tension and proteinuria. Simultaneously, metabotropic glutamate receptor 1 mRNA and protein expressions were upregulated in the rat hippocampus. These findings indicate that increased sion of metabotropic glutamate receptor 1 promotes the occurrence of high-fat diet-induced preeclampsia in pregnant rats.
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Affiliation(s)
- Jing Ge
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang 110000, Liaoning Province, China ; The General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China
| | - Jun Wang
- The General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China
| | - Dan Xue
- Department of Gynecology and Obstetrics, People's Liberation Army No. 202 Hosiptal, Shenyang 110003, Liaoning Province, China
| | - Zhengsheng Zhu
- Dantu District Sanitary Supervision Institute, Zhenjiang 212001, Jiangsu Provicne, China
| | - Zhenyu Chen
- Department of Gynecology and Obstetrics, People's Liberation Army No. 202 Hosiptal, Shenyang 110003, Liaoning Province, China
| | - Xiaoqiu Li
- The General Hospital of Shenyang Military Region, Shenyang 110016, Liaoning Province, China
| | - Dongfeng Su
- Department of Neurology, the 463 Hospital of Chinese PLA, Shenyang 110042, Liaoning Province, China
| | - Juan Du
- Department of Gynecology and Obstetrics, Shengjing Hospital of China Medical University, Shenyang 110000, Liaoning Province, China
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Khan UI, Ogorodnikova AD, Xu L, Wang D, Wassertheil-Smoller S, Ho GYF, Sowers MFR, Rajpathak SN, Allison MA, Mackey RH, Vitolins MZ, Manson JE, Wildman RP. The adipokine profile of metabolically benign obese and at-risk normal weight postmenopausal women: the Women's Health Initiative Observational Study. Obesity (Silver Spring) 2014; 22:786-94. [PMID: 24357553 PMCID: PMC3883802 DOI: 10.1002/oby.20139] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/15/2012] [Accepted: 10/12/2012] [Indexed: 01/16/2023]
Abstract
OBJECTIVE Nearly, a third of obese individuals, termed metabolically benign obese, have a low burden of adiposity-related cardiometabolic abnormalities, whereas a substantial proportion of normal-weight individuals possess risk factors. METHODS In cross-sectional analyses of 699 normal weight and 1,294 overweight/obese postmenopausal women enrolled in a nested case-control stroke study ancillary to the Women's Health Initiative Observational Study, we compared levels of adiponectin, leptin, and resistin among metabolically benign normal weight, at-risk normal weight, metabolically benign obese, and at-risk obese women using components of the ATP III definition of the metabolic syndrome (metabolically benign: ≤1 of the four components; at-risk phenotype: ≥2 components or diabetes). RESULTS Overall, 382/699 normal-weight women (54.6%) and 328/1,194 overweight/obese women (27.5%) were metabolically benign. Among normal-weight women, at-risk women had higher leptin and lower adiponectin levels compared to metabolically benign women; multivariate-adjusted odds ratios were significant for having leptin (OR: 2.51; 95% CI: 1.28-5.01) and resistin (1.46; 1.03-2.07) in the top tertile and adiponectin in the bottom tertile (2.64; 1.81-3.84). Compared to metabolically benign overweight/obese women, at-risk obese women had higher odds of having leptin in the top tertile (1.62; 1.24-2.12) and adiponectin in the bottom tertile (2.78; 2.04-3.77). CONCLUSIONS Overall, metabolically benign overweight/obese women had an intermediate adipokine profile (between at-risk obese and metabolically benign normal-weight women), whereas at-risk normal-weight women had a less favorable profile compared to metabolically benign normal-weight women. As adiponectin was the only adipokine independent of BMI, it may be most likely to have a role in the etiological pathway of these phenotypes.
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Affiliation(s)
- Unab I Khan
- Department of Pediatrics, Albert Einstein College of Medicine, Bronx, New York, USA
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Toth PP, McCullough PA, Wegner MS, Colley KJ. Lipoprotein-associated phospholipase A2: role in atherosclerosis and utility as a cardiovascular biomarker. Expert Rev Cardiovasc Ther 2014; 8:425-38. [DOI: 10.1586/erc.10.18] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
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Turner RJ, Bushnell CD, Register TC, Sharp FR. Gender-dependent correlations of carotid intima-media thickness with gene expression in blood. Transl Stroke Res 2013; 2:171-8. [PMID: 22287995 DOI: 10.1007/s12975-011-0066-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
The mechanisms underlying gender differences in stroke incidence, risk, and outcome are uncertain. We sought to determine whether transcriptional profiles of circulating blood cells of men and women differentially correlated with carotid artery intima-media thickness (CIMT), a predictor of atherosclerosis and stroke risk. Gene expression in whole blood was measured using Affymetrix expression arrays in men (n=17) and women (n=35), aged 45-64 years, with at least one risk factor for stroke. Mean average CIMT was measured using B-mode ultrasound. Expression levels of 746 genes positively and 292 genes negatively correlated with CIMT only in women (p<0.05); 881 genes positively and 597 genes negatively correlated with CIMT only in men (p<0.05). Forty-one genes correlated with CIMT in men and women, but in opposite directions. These genes were associated with estrogen, cholesterol and lipid metabolism, inflammation, coagulation, and vasoreactivity. This pilot study provides the first proof of principle that gene expression in blood cells correlates with CIMT. These results point to potential pathophysiological mechanisms underlying sex differences in stroke risk. Since the sample size is small, the findings are preliminary and need to be confirmed in independent, larger studies.
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Affiliation(s)
- Renée J Turner
- Department of Neurology and M.I.N.D. Institute, University of California at Davis, Sacramento, CA 95817, USA
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Paynter NP, Everett BM, Cook NR. Cardiovascular disease risk prediction in women: is there a role for novel biomarkers? Clin Chem 2013; 60:88-97. [PMID: 24100805 DOI: 10.1373/clinchem.2013.202796] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
Abstract
BACKGROUND Risk prediction is an integral part of the current US guidelines for cardiovascular disease in women. Although current risk prediction algorithms exist to identify women at increased 10-year risk of cardiovascular disease (CVD), clinicians and researchers have been interested in developing novel biomarkers that might improve predictive accuracy further. These biomarkers have led to important insights into the pathophysiology of CVD, but results for their ability to improve prediction or guide preventive therapy have been mixed. The incidence of CVD is lower in women than men, and the effects of a number of traditional biomarkers on CVD risk differ in women compared to men. Both of these factors influence the ability to accurately predict CVD risk. CONTENT We review the distinctive aspects of CVD risk prediction in women, discuss the statistical challenges to improved risk prediction, and discuss a number of biomarkers in varying stages of development with a range of performance in prediction. SUMMARY A variety of biomarkers from different pathophysiologic pathways have been evaluated for improving CVD risk. While many have been incompletely studied or have not been shown to improve risk prediction in women, others, such as high-sensitivity troponin T, have shown promise in improving risk prediction. Increasing inclusion of women in CVD studies will be crucial to providing opportunities to evaluate future biomarkers.
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Affiliation(s)
- Nina P Paynter
- Division of Preventive Medicine, Brigham and Women's Hospital, Boston, MA
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Yaemsiri S, Sen S, Tinker LF, Robinson WR, Evans RW, Rosamond W, Wasserthiel-Smoller S, He K. Serum fatty acids and incidence of ischemic stroke among postmenopausal women. Stroke 2013; 44:2710-7. [PMID: 23899914 DOI: 10.1161/strokeaha.111.000834] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND AND PURPOSE Although studies have linked types of fatty acids with coronary heart disease, data on individual fatty acids and risk of ischemic stroke are limited. We aimed to examine the associations between serum fatty acid concentrations and incidence of ischemic stroke and its subtypes. METHODS We conducted a prospective case-control study nested in the Women's Health Initiative Observational Study cohort of postmenopausal US women aged 50 to 79 years. Between 1993 and 2003, incident cases of ischemic stroke were matched 1:1 to controls on age, race, and length of follow-up (964 matched pairs). Conditional logistic regression was used to estimate odds ratios and 99.9% confidence intervals (CI) for ischemic stroke and its subtypes. RESULTS The multivariable-adjusted odds ratios and 99.9% CI of ischemic stroke associated with a 1-SD increment in serum fatty acid concentration were 1.38 (99.9% CI, 1.05-1.83) for linoelaidic acid (18:2tt, SD=0.04%), 1.27 (99.9% CI, 1.06-1.51) for palmitic acid (16:0, SD=2.74%), 1.20 (99.9% CI, 1.01-1.43) for oleic acid (18:1n9, SD=2.32%), 0.72 (99.9% CI, 0.59-0.87) for docosapentaenoic acid (22:5n3, SD=0.18%), 0.72 (99.9% CI, 0.59-0.87) for docosahexaenoic acid (22:6n3, SD=0.91%), and 0.81 (99.9% CI, 0.67-0.98) for arachidonic acid (20:4n6, SD=2.02%). These associations were generally consistent for atherothrombotic and lacunar stroke but not cardioembolic stroke. CONCLUSIONS These findings suggest that individual serum trans, saturated, and monounsaturated fatty acids are positively associated with particular ischemic stroke subtypes, whereas individual n3 and n6 polyunsaturated fatty acids are inversely associated.
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Affiliation(s)
- Sirin Yaemsiri
- From the Department of Epidemiology, University of North Carolina, Chapel Hill, NC (S.Y., W.R.R., W.R., K.H.); National Centers for Health Statistics, Centers for Disease Control and Prevention, Hyattsville, MD (S.Y.); Department of Neurology, University of South Carolina, Columbia, SC (S.S.); Fred Hutchinson Cancer Research Center, Seattle, WA (L.F.T.); Department of Epidemiology, University of Pittsburgh, Pittsburgh, PA (R.W.E.); Department of Epidemiology, Albert Einstein College of Medicine, Bronx, NY (S.W.S.); and Department of Epidemiology and Biostatistics, Indiana University, Bloomington, IN (K.H.)
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Therapeutic Options to Reduce Lp-PLA2 Levels and the Potential Impact on Vascular Risk Reduction. CURRENT TREATMENT OPTIONS IN CARDIOVASCULAR MEDICINE 2013; 15:313-21. [DOI: 10.1007/s11936-013-0239-4] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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17
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Camilleri G, Borg M, Brincat S, Schembri-Wismayer P, Brincat M, Calleja-Agius J. The role of cytokines in cardiovascular disease in menopause. Climacteric 2012; 15:524-30. [PMID: 22992012 DOI: 10.3109/13697137.2012.700743] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
Various studies suggest that increased levels of pro-inflammatory cytokines play a key role in the declining ovarian function and the resulting complications associated with menopause. In this review article, the authors outline the role of pro- and anti-inflammatory cytokines in cardiovascular disease during menopause.
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Affiliation(s)
- G Camilleri
- Department of Anatomy, Faculty of Medicine and Surgery, University of Malta, Msida, Malta
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18
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Cook NR, Paynter NP, Manson JE, Martin LW, Robinson JG, Wassertheil-Smoller S, Ridker PM. Clinical utility of lipoprotein-associated phospholipase A₂ for cardiovascular disease prediction in a multiethnic cohort of women. Clin Chem 2012; 58:1352-63. [PMID: 22859728 DOI: 10.1373/clinchem.2012.188870] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
BACKGROUND Findings regarding the association of lipoprotein-associated phospholipase A₂ (Lp-PLA2) activity and mass with incident cardiovascular disease (CVD) have been inconsistent, and their role in risk prediction is uncertain. METHODS A case-cohort sample from the Women's Health Initiative Observational Study (WHI-OS) comprised 1821 CVD cases and a reference subcohort of 1992 women. We used Cox regression models with inverse sampling weights to assess the association of Lp-PLA2 mass and activity with CVD (myocardial infarction, stroke, and CVD mortality). RESULTS Subcohort means were 184.3 mmol/min/mL for Lp-PLA2 activity and 499.2 μg/L for Lp-PLA2 mass, with 99% having mass above 200 μg/L, the clinically recommended cut point. Both activity and mass were positively associated with incident CVD in age- and race/ethnicity-adjusted analyses. Following adjustment according to CVD risk factors, the association with activity became null (hazard ratio = 1.02 for top vs bottom quartile, 95% CI = 0.79-1.33, P for trend = 0.65), but the association with mass remained (hazard ratio = 1.84, 95% CI = 1.45-2.34, P for trend < 0.0001). In contrast to blood pressure, HDL, and hsCRP, reclassification statistics for Lp-PLA2 mass did not suggest improvement for overall CVD after full adjustment. CONCLUSIONS In the WHI-OS Lp-PLA2 mass, but not activity, was independently associated with CVD. However, model fit did not significantly improve with Lp-PLA2 mass, and assay calibration remains a clinical concern.
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Affiliation(s)
- Nancy R Cook
- Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02215, USA.
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19
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Gregson J, Stirnadel-Farrant HA, Doobaree IU, Koro C. Variation of lipoprotein associated phospholipase A2 across demographic characteristics and cardiovascular risk factors: a systematic review of the literature. Atherosclerosis 2012; 225:11-21. [PMID: 22784637 DOI: 10.1016/j.atherosclerosis.2012.06.020] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/26/2012] [Revised: 06/11/2012] [Accepted: 06/13/2012] [Indexed: 12/23/2022]
Abstract
BACKGROUND Lipoprotein association phospholipase A2 (Lp-PLA(2)), an enzyme which has been found in atherosclerotic plaque is currently under investigation in large Phase III clinical trials of vascular disease prevention. We assessed in a variety of different population settings variation of Lp-PLA(2) mass and activity across gender, ethnicity, diabetes, kidney disease and metabolic syndrome. We also assessed correlations with measures of circulating lipids, systemic inflammation and adiposity. METHODS Systematic review of studies measuring Lp-PLA(2) and at least one of the relevant characteristics in >50 participants. RESULTS We identified a total of 77 studies involving 102,499 participants meeting the inclusion criteria. Lp-PLA(2) mass and activity were consistently approximately 10% higher in males than females and 15% higher in Caucasians than African Americans or Hispanics. There were no clear associations of Lp-PLA(2) mass or activity with type II diabetes, markers of systemic inflammation (C-reactive protein, fibrinogen) or with body mass index. Correlations of Lp-PLA(2) mass or activity with low density lipoprotein cholesterol and apolipoprotein B were moderate and positive, whilst correlations with high density lipoprotein cholesterol were negative and moderate to weak. There was no clear differences in associations with any of the above characteristics in groups defined based upon prevalent cardiovascular disease or its risk factors. CONCLUSIONS Despite considerable variability in absolute levels of Lp-PLA(2) across studies, the variability of Lp-PLA(2) across gender, ethnicity, and levels of circulating lipids and markers of systemic inflammation are more consistent and appear not to vary importantly across categories defined by CVD or its risk factors.
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Affiliation(s)
- John Gregson
- Department of Public Healthy and Primary Care, University of Cambridge, Cambridge CB1 8RN, United Kingdom.
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Delgado P, Chacón P, Penalba A, Pelegri D, García-Berrocoso T, Giralt D, Santamarina E, Ribó M, Maisterra O, Alvarez-Sabín J, Rosell A, Montaner J. Lipoprotein-Associated Phospholipase A 2 Activity Is Associated with Large-Artery Atherosclerotic Etiology and Recurrent Stroke in TIA Patients. Cerebrovasc Dis 2012; 33:150-8. [DOI: 10.1159/000334193] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2011] [Accepted: 09/30/2011] [Indexed: 11/19/2022] Open
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Liu J, Hong Y, Qi Y, Zhao F, Zhao D. Systematic Review of the Association between Lipoprotein-Associated Phospholipase A2 and Atherosclerosis. NORTH AMERICAN JOURNAL OF MEDICINE & SCIENCE 2011; 4:201-211. [PMID: 26339459 PMCID: PMC4555875 DOI: 10.7156/v4i4p201] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a novel inflammatory biomarker. Basic research has shown that Lp-PLA2 is involved in the pathogenesis of atherosclerosis. In the past decade, an increasing number of epidemiological studies have investigated the association of Lp-PLA2 with atherosclerosis, but its roles in the different stages of atherosclerosis are not established. By undertaking a systematic review of the epidemiological studies on the relationship between Lp-PLA2 and atherosclerotic cardiovascular disease (CVD)/subclinical atherosclerosis, we tried to evaluate the relationship between Lp-PLA2 and the different stages of atherosclerosis. MEDLINE, Cochrane Library, and National Knowledge Infrastructure (CNKI) were searched up to September 1st, 2011. The references in all the located articles were manually searched. Epidemiological studies on the association of Lp-PLA2 with CVD and subclinical atherosclerosis, with total CVD, coronary heart disease (CHD), stroke, and subclinical atherosclerosis as their observation endpoints or outcome variables, were included in this study. Studies which did not assess the hazard ratio (HR), relative risk (RR), or odds ratio (OR) of Lp-PLA2 or which did not adjust for other known risk factors were excluded. The general information, study design, sample size, outcome variables and their definitions, follow-up duration, Lp-PLA2 measurements, variables adjusted in the multivariate analysis and main results in the literatures were retrieved. Thirty-nine studies were enrolled in this systematic review. Thirty-three studies (49, 260 subjects) investigated the relationship between Lp-PLA2 and CVD, among which 31 showed that increased Lp-PLA2 is associated to high risk for incidence or mortality of CVD: HR/RR per 1 standard deviation (SD) increase = 1.17-1.40; RR for the highest as compared with the lowest quartile was 1.41-3.75 (1.8-2.5 in most studies). Six studies (four cross-sectional studies and two case-control studies, with an overall sample size of 5,537) explored the relationship between Lp-PLA2 and subclinical atherosclerosis; among them, two studies demonstrated that Lp-PLA2 was associated with coronary artery calcification in young adults and men. In conclusion, many epidemiological studies have demonstrated that Lp-PLA2 increases the risk of clinical CVD events. However, whether there is a similar association between Lp-PLA2 and subclinical atherosclerosis remains unclear. Whether Lp-PLA2 exerts its effect during the occurrence of clinical events promoted by unstable plaques or at the early stage of atherosclerosis needs to be clarified in further prospective studies.
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Affiliation(s)
- Jing Liu
- Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Yuling Hong
- Division for Heart Disease & Stroke Prevention, Center for Disease Control and Prevention, Atlanta, Georgia
| | - Yue Qi
- Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Fan Zhao
- Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
| | - Dong Zhao
- Beijing An Zhen Hospital, Capital Medical University, Beijing Institute of Heart, Lung and Blood Vessel Diseases, Beijing, China
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Sander D, Poppert H, Sander K, Etgen T. The role of intima-media-thickness, ankle-brachial-index and inflammatory biochemical parameters for stroke risk prediction: a systematic review. Eur J Neurol 2011; 19:544-e36. [DOI: 10.1111/j.1468-1331.2011.03510.x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Abstract
This review provides a summary of the protein and RNA biomarkers that have been studied for the diagnosis and assessment of ischemic stroke. Many of the biomarkers identified relate to the pathophysiology of ischemic stroke, including ischemia of CNS tissue, acute thrombosis and inflammatory response. These biomarkers are summarized by their intended clinical application in ischemic stroke including diagnosis, prediction of stroke severity and outcome, and stratification of patients for stroke therapy. Among the biomarkers discussed are recent whole genome studies using RNA expression profiles to diagnose ischemic stroke and stroke etiology. Though many candidate blood based biomarkers for ischemic stroke have been identified, none are currently used in clinical practice. With further well designed study and careful validation, the development of blood biomarkers to improve the care of patients with ischemic stroke may be achieved.
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Affiliation(s)
- Glen C Jickling
- Department of Neurology and MIND Institute, University of California at Davis, Sacramento, CA 95817, USA.
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Wildman RP, Kaplan R, Manson JE, Rajkovic A, Connelly SA, Mackey RH, Tinker LF, Curb JD, Eaton CB, Wassertheil-Smoller S. Body size phenotypes and inflammation in the Women's Health Initiative Observational Study. Obesity (Silver Spring) 2011; 19:1482-91. [PMID: 21233809 PMCID: PMC3124587 DOI: 10.1038/oby.2010.332] [Citation(s) in RCA: 62] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Individuals with "metabolically benign" obesity (obesity unaccompanied by hypertension, dyslipidemia, and diabetes) are not at elevated 10-year risk of cardiovascular disease (CVD) compared to normal weight individuals. It remains unclear whether these obese individuals or normal weight individuals with clustering of cardiometabolic factors display heightened immune activity. Therefore, we characterized levels of acute-phase reactants (C-reactive protein (CRP), interleukin-6 (IL-6), tumor necrosis factor-α (TNF-α), white blood cell (WBC) count), adhesion molecules (E-selectin, vascular cell adhesion molecule-1), and coagulation products (fibrinogen, plasminogen activator inhibitor-1 (PAI-1)) among four body size phenotypes (normal weight with 0/1 vs. ≥2 metabolic syndrome components/diabetes and overweight/obesity with 0/1 vs. ≥2 metabolic syndrome components/diabetes) in cross-sectional analyses of 1,889 postmenopausal women from the Women's Health Initiative Observational Study (WHI-OS) nested case-control stroke study. Higher levels of all three inflammatory marker categories were found among women with overweight/obesity or ≥2 metabolic syndrome components or diabetes. Compared to normal weight women with 0 or 1 metabolic syndrome components, normal weight women with ≥2 metabolic syndrome components or diabetes were more likely to have ≥3 inflammatory markers in the top quartile (multivariate odds ratio (OR) 2.0, 95% confidence interval (CI): 1.3-3.0), as were overweight/obese women with 0 or 1 metabolic syndrome components (OR 2.3; 95% CI: 1.5-3.5). Overweight/obese women with ≥2 metabolic syndrome components or diabetes had the highest OR (OR 4.2; 95% CI: 2.9-5.9). Despite findings that metabolically benign obese individuals are not at increased 10-year risk of CVD compared to normal weight individuals, the current results suggest that overweight/obese women without clustering of cardiometabolic risk factors still possess abnormal levels of inflammatory markers.
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Affiliation(s)
- Rachel P Wildman
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, New York, USA.
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25
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Massot A, Pelegri D, Penalba A, Arenillas J, Boada C, Giralt D, Ribó M, Molina CA, Rosell A, Alvarez-Sabín J, Chacón P, Rovira A, Delgado P, Montaner J. Lipoprotein-associated phospholipase A2 testing usefulness among patients with symptomatic intracranial atherosclerotic disease. Atherosclerosis 2011; 218:181-7. [PMID: 21620406 DOI: 10.1016/j.atherosclerosis.2011.04.031] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/27/2010] [Revised: 04/14/2011] [Accepted: 04/21/2011] [Indexed: 10/18/2022]
Abstract
BACKGROUND AND PURPOSE Circulating lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) has emerged as a novel biomarker for cardiovascular diseases. Our aim was to determine Lp-PLA(2) mass and activity in a selected cohort of first-ever transient ischemic attack (TIA) or ischemic stroke patients with intracranial atherosclerotic disease (ICAD) and to investigate its relationship with the presence of classical vascular risk factors, response to secondary prevention treatments and risk of recurrent vascular events. METHODS Lp-PLA(2) mass and activity were measured 3 months after TIA or stroke by means of the PLAC test and CAM-assay (diaDexus, Inc.) respectively in 75 patients. Classic vascular risk factors, preventive treatments and clinical characteristics at the time of the index event were recorded. Follow-up transcranial Doppler ultrasonography (TCD) was performed and the presence of a new vascular event was assessed every 6 months. RESULTS Several preventive treatments (statins and clopidogrel) were significantly associated with lower Lp-PLA(2) mass and activity. During follow-up (median time 23 months), eighteen patients (24%) suffered a new vascular event. Baseline factors associated with new vascular events were: history of coronary artery disease, number of intracranial stenoses detected by TCD and also Lp-PLA(2) activity, which was the only independent predictor for new vascular events (hazard ratio 2.89; 95% CI 1.029 to 8.096; p=0.044) after multivariate analysis (Cox regression). CONCLUSIONS Lp-PLA(2) activity might be a useful tool to identify intracranial large-artery occlusive disease patients at higher risk of suffering new vascular events.
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Affiliation(s)
- Andreu Massot
- Neurovascular Research Laboratory, Department of Neurology, Autonomous University of Barcelona, Vall d'Hebron Hospital, Barcelona, Spain
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Rajpathak SN, Kaplan RC, Wassertheil-Smoller S, Cushman M, Rohan TE, McGinn AP, Wang T, Strickler HD, Scherer PE, Mackey R, Curb D, Ho GYF. Resistin, but not adiponectin and leptin, is associated with the risk of ischemic stroke among postmenopausal women: results from the Women's Health Initiative. Stroke 2011; 42:1813-20. [PMID: 21546486 DOI: 10.1161/strokeaha.110.607853] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/12/2023]
Abstract
BACKGROUND AND PURPOSE Adipose tissue is considered an endocrine organ that secretes adipokines, which possibly mediate the effects of obesity on the risk of cardiovascular disease. However, there are yet limited prospective data on the association between circulating adipokine levels and the risk of ischemic stroke. We aimed to examine the associations of 3 adipokines (adiponectin, leptin, and resistin) with the risk of ischemic stroke. METHODS We conducted a prospective nested case-control study (972 stroke cases and 972 matched control subjects) within the Women's Health Initiative Observational Study cohort. The control subjects were matched to cases on age, race/ethnicity, date of study enrollment, and follow-up time. RESULTS Adipokine levels were associated with established stroke risk factors such as obesity and systolic blood pressure. Adjusted for body mass index, the ORs for incident ischemic stroke comparing the highest (Quartile 4) with the lowest quartile (Quartile 1) were 0.81 (95% CI, 0.61 to 1.08; P trend=0.068) for adiponectin, 1.15 (95% CI, 0.83 to 1.59; P trend=0.523) for leptin, and 1.57 (95% CI, 1.18 to 2.08; P trend=0.002) for resistin. The association for resistin remained significant even after accounting for established stroke risk factors (OR, 1.39; 95% CI, 1.01 to 1.90; P trend=0.036). Further adjustment for markers for inflammation, angiogenesis, and endothelial function also did not affect our results. CONCLUSIONS Circulating levels of resistin, but not those of adiponectin or leptin, are associated with an increased risk of incident ischemic stroke in postmenopausal women, independent of obesity and other cardiovascular disease risk factors.
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Affiliation(s)
- Swapnil N Rajpathak
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA
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Prentice RL. Biomarkers and the risk of stroke in the Women's Health Initiative. WOMEN'S HEALTH (LONDON, ENGLAND) 2011; 7:269-273. [PMID: 21612347 DOI: 10.2217/whe.11.17] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/30/2023]
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Lipoprotein associated phospholipase A(2): role in atherosclerosis and utility as a biomarker for cardiovascular risk. EPMA J 2011; 2:27-38. [PMID: 21654904 PMCID: PMC3084931 DOI: 10.1007/s13167-011-0063-4] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2010] [Accepted: 01/17/2011] [Indexed: 02/08/2023]
Abstract
Atherosclerosis and its clinical manifestations are widely prevalent throughout the world. Atherogenesis is highly complex and modulated by numerous genetic and environmental risk factors. A large body of basic scientific and clinical research supports the conclusion that inflammation plays a significant role in atherogenesis along the entire continuum of its progression. Inflammation adversely impacts intravascular lipid handling and metabolism, resulting in the development of macrophage foam cell, fatty streak, and atheromatous plaque formation. Given the enormous human and economic cost of myocardial infarction, ischemic stroke, peripheral arterial disease and amputation, and premature death and disability, considerable effort is being committed to refining our ability to correctly identify patients at heightened risk for atherosclerotic vascular disease and acute cardiovascular events so that they can be treated earlier and more aggressively. Serum markers of inflammation have emerged as an important component of risk factor burden. Lipoprotein-associated phospholipase A2 (Lp-PLA(2)) potentiates intravascular inflammation and atherosclerosis. A variety of epidemiologic studies support the utility of Lp-PLA(2) measurements for estimating and further refining cardiovascular disease risk. Drug therapies to inhibit Lp-PLA(2) are in development and show considerable promise, including darapladib, a specific molecular inhibitor of the enzyme. In addition to substantially inhibiting Lp-PLA(2) activity, darapladib reduces progression of the necrotic core volume of human coronary artery atheromatous plaque. The growing body of evidence points to an important role and utility for Lp-PLA(2) testing in preventive and personalized clinical medicine.
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Bekci TT, Kayrak M, Kiyici A, Maden E, Ari H, Kaya Z, Teke T, Akilli H. The association among lipoprotein-associated phospholipase A2 levels, total antioxidant capacity and arousal in male patients with OSA. Int J Med Sci 2011; 8:369-76. [PMID: 21698055 PMCID: PMC3119379 DOI: 10.7150/ijms.8.369] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/17/2011] [Accepted: 04/25/2011] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND The mechanisms of the increased cardiac and vascular events in patients with OSA are not well understood. Arousal which is an important component of OSA was associated with increased sympathetic activation and electrocardiographic changes which prone to arrhythmias. We planned to examine the association among arousal, circulating Lp-PLA2 and total antioxidant capacity in male patients with OSA. METHODS Fifty male patients with newly diagnosed OSA were enrolled the study. A full-night polysomnography was performed and arousal index was obtained. Lp-PLA2 concentrations were measured in serum samples with the PLAC Test. Total antioxidant capacity in patients was determined with Antioxidant Assay Kit. RESULTS Arousal was positively correlated with LP-PLA2 levels (r=0.43, p=0.002) and was negatively correlated with total antioxidant capacity (r= -0.29, p=0.04). Elevated LP-PLA2 levels and decreased total antioxidant activities were found in the highest arousal quartile compared with the lowest and 2nd quartiles (p=0.02, p=0.05, respectively). LP-PLA2 was an independently predictor of arousal index in regression model (β=0.357, p=0.002) CONCLUSIONS This study demonstrated a moderate linear relationship between arousal and LP-PLA2 levels. Also, total antioxidant capacities were decreased in the higher arousal index. Based on the study result, the patients with higher arousal index may be prone to vascular events.
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Affiliation(s)
- Taha T Bekci
- Department of Pulmonary Medicine, Konya Education and Research Hospital, Konya/ Turkey.
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Mallat Z, Lambeau G, Tedgui A. Lipoprotein-associated and secreted phospholipases A₂ in cardiovascular disease: roles as biological effectors and biomarkers. Circulation 2010; 122:2183-200. [PMID: 21098459 DOI: 10.1161/circulationaha.110.936393] [Citation(s) in RCA: 128] [Impact Index Per Article: 9.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Affiliation(s)
- Ziad Mallat
- INSERM, Paris-Cardiovascular Research Center, Université Paris Descartes, UMR, Paris, France
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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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Abstract
AIMS The aim of this article is to provide an overview of stroke in women and describe modifiable and non-modifiable risk factors for stroke. DATA SYNTHESIS Data supporting this article come from the National Center for Health Statistics, from American Heart Association publications, and from some of the large, multicenter trials and observational studies that inform guidelines for prevention of stroke. These data indicate that stroke is the third leading cause of death in women, that risk for stroke rises rapidly with age, and that the strongest risk factors for stroke are high blood pressure and atrial fibrillation, as well as diabetes and smoking. Risk rises rapidly when two or more risk factors are present. Hormone therapy in postmenopausal women increases risk of ischemic, but not hemorrhagic stroke, by 40-50%. Biomarkers of inflammation are associated with stroke risk. Other risk factors include certain lipids, physical inactivity, and low potassium diets. Although there has been improvement in the past decade, control of hypertension is inadequate in older women and many strokes could be prevented by better treatment of hypertension. CONCLUSION Death and disability from stroke can be reduced with modification, treatment, and better control of risk factors like hypertension, diabetes and atrial fibrillation.
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Rajpathak SN, Wang T, Wassertheil-Smoller S, Strickler HD, Kaplan RC, McGinn AP, Wildman RP, Rosenbaum D, Rohan TE, Scherer PE, Cushman M, Ho GYF. Hepatocyte growth factor and the risk of ischemic stroke developing among postmenopausal women: results from the Women's Health Initiative. Stroke 2010; 41:857-62. [PMID: 20203323 PMCID: PMC3903044 DOI: 10.1161/strokeaha.109.567719] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/28/2009] [Accepted: 01/05/2010] [Indexed: 01/04/2023]
Abstract
BACKGROUND AND PURPOSE Hepatocyte growth factor (HGF) is a potent angiogenic factor and may play a role in the development and progression of atherosclerotic lesions, the underlying mechanism of cardiovascular disease. However, there have been no prospective studies examining the relationship between HGF levels and risk of stroke. METHODS We conducted a nested case-control study (972 incident stroke cases and 1:1 age-matched and race-matched controls) to prospectively evaluate the association between plasma HGF and risk of ischemic stroke within the Women's Health Initiative Observational Study, a cohort of postmenopausal women aged 50 to 79 years. RESULTS Baseline HGF levels were correlated positively with body mass index, systolic blood pressure, low-density lipoprotein cholesterol, insulin resistance, and inflammatory markers, such as C-reactive protein, and inversely with high-density lipoprotein cholesterol (all P<0.05). Baseline HGF levels were higher among cases than controls (geometric means, 601.8 vs 523.2 pg/mL; P=0.003). Furthermore, the risk of incident ischemic stroke was significantly greater among women in the highest vs lowest quartile of plasma HGF levels (OR, 1.46; 95% CI, 1.12-1.91; P(trend)=0.003) in a conditional logistic regression model that adjusted for body mass index. These results were only slightly attenuated after further adjustment for additional stroke risk factors (OR, 1.39; 95% CI, 1.04-1.85; P(trend)=0.023). CONCLUSIONS Circulating levels of HGF are associated with an increased risk of incident ischemic stroke, independent of obesity and other risk factors for cardiovascular disease, among postmenopausal women aged 50 to 79 years.
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Affiliation(s)
- Swapnil N Rajpathak
- Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, USA.
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Hatoum IJ, Nelson JJ, Cook NR, Hu FB, Rimm EB. Dietary, lifestyle, and clinical predictors of lipoprotein-associated phospholipase A2 activity in individuals without coronary artery disease. Am J Clin Nutr 2010; 91:786-93. [PMID: 20107195 PMCID: PMC2824159 DOI: 10.3945/ajcn.2009.28870] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022] Open
Abstract
BACKGROUND Elevated lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) may be positively associated with risk of coronary artery disease, yet little is known about potentially modifiable factors related to Lp-PLA(2). OBJECTIVE The aim of this study was to determine dietary, lifestyle, and clinical measures associated with Lp-PLA(2) activity. DESIGN We measured Lp-PLA(2) activity in 853 female participants of the Nurses' Health Study and 878 male participants of the Health Professionals Follow-Up Study who were free of cancer and cardiovascular disease. Multivariable linear regression models were used to assess the relation between potentially modifiable factors and Lp-PLA(2). RESULTS The replacement of 5% of energy from carbohydrates with energy from protein was associated with 2.2 nmol . min(-1) . mL(-1) lower levels of Lp-PLA(2) (95% CI: -3.1, -0.4) activity, and every 15-g/d increase in alcohol consumption was associated with 4.4 nmol . min(-1) . mL(-1) lower levels of Lp-PLA(2) activity (95% CI: -6.4, -2.4). Smoking (beta = 10.2; 95% CI: 4.8, 15.5), being overweight (beta = 7.5; 95% CI: 3.6, 11.3), aspirin use (beta = 6.0; 95% CI: 2.1, 10.0), hypercholesterolemia (beta = 15.0; 95% CI: 11.3, 18.8), and age (beta = 2.5; 95% CI: 1.34, 3.74) were associated with elevated Lp-PLA(2) activity, whereas postmenopausal hormone use (beta = -15.8; 95% CI: -19.4, -12.1) and cholesterol medication use (beta = -9.6; 95% CI: -18.2, -1.1) were inversely associated. CONCLUSION We found that not smoking, use of postmenopausal hormones, having a body mass index (in kg/m(2)) < or =25, increased alcohol consumption, and increased protein consumption all represent potential modifiable factors that may favorably influence Lp-PLA(2) activity.
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Affiliation(s)
- Ida J Hatoum
- Department of Nutrition and Epidemiology, Harvard School of Public Health, Boston MA, USA
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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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37
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Bale B, Doneen A, Wegner M. The identification of occult cardiovascular disease through the use of a novel biomarker: a case report. J Clin Lipidol 2009; 3:351-4. [PMID: 21291834 DOI: 10.1016/j.jacl.2009.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2009] [Revised: 08/27/2009] [Accepted: 08/29/2009] [Indexed: 10/20/2022]
Affiliation(s)
- Bradley Bale
- Heart Health Program Grace Clinic and School of Medicine, Texas Tech Health Sciences Center, 4515 Marsha Sharp Freeway, Lubbock, TX 79407, USA
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38
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Cucchiara BL, Messe SR, Sansing L, MacKenzie L, Taylor RA, Pacelli J, Shah Q, Kasner SE. Lipoprotein-Associated Phospholipase A
2
and C-Reactive Protein for Risk-Stratification of Patients With TIA. Stroke 2009; 40:2332-6. [PMID: 19461040 DOI: 10.1161/strokeaha.109.553545] [Citation(s) in RCA: 63] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background and Purpose—
Lipoprotein-associated phospholipase A
2
(Lp-PLA
2
) is a marker of unstable atherosclerotic plaque, and is predictive of both primary and secondary stroke in population-based studies.
Methods—
We conducted a prospective study of patients with acute TIA who presented to the ED. Clinical risk scoring using the ABCD
2
score was determined and Lp-PLA
2
mass (LpPLA
2
-M) and activity (LpPLA
2
-A) and high-sensitivity C-reactive protein (CRP) were measured. The primary outcome measure was a composite end point consisting of stroke or death within 90 days or identification of a high-risk stroke mechanism requiring specific early intervention (defined as ≥50% stenosis in a vessel referable to symptoms or a cardioembolic source warranting anticoagulation).
Results—
The composite outcome end point occurred in 41/167 (25%) patients. LpPLA
2
-M levels were higher in end point-positive compared to -negative patients (mean, 192±48 ng/mL versus 175±44 ng/mL,
P
=0.04). LpPLA
2
-A levels showed similar results (geometric mean, 132 nmol/min/mL, 95% CI 119 to 146 versus 114 nmol/min/mL, 95% CI 108 to 121,
P
=0.01). There was no relationship between CRP and outcome (
P
=0.82). Subgroup analysis showed that both LpPLA
2
-M (
P
=0.04) and LpPLA
2
-A (
P
=0.06) but not CRP (
P
=0.36) were elevated in patients with >50% stenosis. In multivariate analysis using cut-off points defined by the top quartile of each marker, predictors of outcome included LpPLA
2
-A (OR 3.75, 95% CI 1.58 to 8.86,
P
=0.003) and ABCD
2
score (OR 1.30 per point, 95% CI 0.97 to 1.75,
P
=0.08).
Conclusion—
Many patients with TIA have a high-risk mechanism (large vessel stenosis or cardioembolism) or will experience stroke/death within 90 days. In contrast to CRP, both Lp-PLA
2
mass and activity were associated with this composite end point, and LpPLA
2
-A appears to provide additional prognostic information beyond the ABCD
2
clinical risk score alone.
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Affiliation(s)
- Brett L. Cucchiara
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
| | - Steve R. Messe
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
| | - Lauren Sansing
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
| | - Larami MacKenzie
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
| | - Robert A. Taylor
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
| | - James Pacelli
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
| | - Qaisar Shah
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
| | - Scott E. Kasner
- From the University of Pennsylvania (B.L.C., S.R.M., L.S., L.M., S.E.K.), Philadelphia; the University of Minnesota (R.A.T.), Minneapolis; the Lancaster General Hospital (J.P.), Pa; and the Abington Memorial Hospital (Q.S.), Pa
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Reddy KJ, Singh M, Bangit JR, Batsell RR. The role of lipoprotein-associated phospholipase A2 on cardiovascular disease risk assessment and plaque rupture: a clinical review. J Clin Lipidol 2009; 3:85-93. [DOI: 10.1016/j.jacl.2009.01.004] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2009] [Accepted: 01/17/2009] [Indexed: 12/11/2022]
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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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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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Abstract
Multiple cardiovascular biomarkers are associated with increased cardiovascular disease (CVD) risk. Lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) appears to be relatively unique in its high specificity for and the causal pathway of plaque inflammation. In both primary and secondary prevention study populations, Lp-PLA(2) was consistently associated with higher cardiovascular risk, and the risk estimate appears to be relatively unaffected by adjustment for conventional CVD risk factors. Risk ratios were similar, whether the mass concentration or activity of the enzyme was measured. The purpose of this article is to review the evidence for the clinical utility of Lp-PLA(2), both as a risk marker and as a risk factor involved in the causal pathway of plaque inflammation and the formation of rupture-prone plaque.
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Affiliation(s)
- Amir Lerman
- Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, 200 First Street SW, Rochester, MN 55905, USA.
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