Association of Lp-PLA2 with digital reactive hyperemia, coronary flow reserve, carotid atherosclerosis and arterial stiffness in coronary artery disease

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• 作者：Ignatios Ikonomidis ; ^{ignoik@gmail.com" class="auth_mail} ; ^{ignoik@otenet.gr" class="auth_mail} ; Nikolaos N.P. Kadoglou ; Vlassis Tritakis ; Ioannis Paraskevaidis ; Kleanthi Dimas ; Paraskevi Trivilou ; Ioannis Papadakis ; Stavros Tzortzis ; Helen Triantafyllidi ; John Parissis ; Maria Anastasiou-Nana ; John Lekakis
• 关键词：Lp-PLA2 ; Coronary artery disease ; Reactive hyperemia index ; Coronary flow reserve ; Carotid intima-media thickness ; Pulse wave velocity ; Prognosis
• 刊名：Atherosclerosis
• 出版年：May, 2014
• 年：2014
• 卷：234
• 期：1
• 页码：34-41
• 全文大小：467 K

文摘

Background

Lipoprotein-associated Phospholipase A2 (Lp-PLA2), has a powerful inflammatory and atherogenic action in the vascular wall and is an independent marker of poor prognosis in coronary artery disease (CAD). We investigate the association of Lp-PLA2 with markers of vascular dysfunction and atherosclerosis with proven prognostic value in CAD.

Methods

In 111 patients with angiographically documented chronic CAD, we measured 1) carotid intima-media thickness (CIMT), 2) reactive hyperemia using fingertip peripheral arterial tonometry (RH-PAT), 3) coronary flow reserve (CFR), by Doppler echocardiography 4) pulse wave velocity (PWV) and 5) blood levels of Lp-PLA2.

Results

Patients with Lp-PLA2 concentration >234.5聽ng/ml (50th percentile) had higher CIMT (1.44聽卤聽0.07 vs. 1.06聽卤聽0.06聽mm), PWV (11.0聽卤聽2.36 vs. 9.7聽卤聽2.38聽m/s) and lower RH-PAT(1.24聽卤聽0.25 vs. 1.51聽卤聽0.53) and CFR (2.39聽卤聽0.75 vs. 2.9聽卤聽0.86) compared to those with lower Lp-PLA (p聽<聽0.05 for all comparisons). Lp-PLA2 was positively associated with CIMT (regression coefficient b: 0.30 per unit of Lp-PLA2, p聽=聽0.02), PWV (b:0.201, p聽=聽0.04) and inversely with RHI-PAT (b:聽鈭?.371, p聽<聽0.001) and CFR (b:鈭?.32, p聽=聽0.002). In multivariate analysis, Lp-PLA2 was an independent determinant of RHI-PAT, CFR, CIMT and PWV in a model including age, sex, smoking, diabetes, dyslipidemia and hypertension (p聽<聽0.05 for all vascular markers). Lp-PLA2, RHI-PAT and CFR were independent predictors of cardiac events during a 3-year follow-up.

Conclusions

Elevated Lp-PLA2 concentration is related with endothelial dysfunction, carotid atherosclerosis, impaired coronary flow reserve and increased arterial stiffness and adverse outcome in CAD patients. These findings suggest that the prognostic role of Lp-PLA2 in chronic CAD may be explained by a generalized detrimental effect of this lipase on endothelial function and arterial wall properties.