Lipoprotein-Associated Phospholipase A2, High-Sensitivity C-Reactive Protein, and Risk for Incident Coronary Heart Disease in Middle-Aged Men and Women in the Atherosclerosis Risk in Communities (ARIC) Study

Christie M. Ballantyne, Ron C. Hoogeveen, Heejung Bang, Josef Coresh, Aaron R. Folsom, Gerardo Heiss, A. Richey Sharrett

Research output: Contribution to journalArticle

522 Citations (Scopus)

Abstract

Background-Measuring C-reactive protein (CRP) has been recommended to identify patients at high risk for coronary heart disease (CHD) with low LDL cholesterol (LDL-C). Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a proinflammatory enzyme associated primarily with LDL. Methods and Results-In a prospective, case cohort study in 12 819 apparently healthy middle-aged men and women in the Atherosclerosis Risk in Communities study, the relation between Lp-PLA2, CRP, traditional risk factors, and risk for CHD events over a period of ≈6 years was examined in a proportional hazards model, stratified by LDL-C. Lp-PLA2 and CRP levels were higher in the 608 cases than the 740 noncases. Both Lp-PLA 2 and CRP were associated with incident CHD after adjustment for age, sex, and race with a hazard ratio of 1.78 for the highest tertile of Lp-PLA2 and 2.53 for the highest category of CRP versus the lowest categories. Lp-PLA2 correlated positively with LDL-C (r=0.36) and negatively with HDL-C (r= -0.33) but not with CRP (r= -0.05). In a model adjusted for traditional risk factors including LDL-C, the association of Lp-PLA2 with CHD was attenuated and not statistically significant. For individuals with LDL-C below the median (130 mg/dL), Lp-PLA2 and CRP were both significantly and independently associated with CHD in fully adjusted models. For individuals with LDL-C < 130 mg/dL, those with both Lp-PLA2 and CRP levels in the highest tertile were at the greatest risk for a CHD event. Conclusions-Lp-PLA2 and CRP may be complementary in identifying individuals at high CHD risk who have low LDL-C.

Original languageEnglish (US)
Pages (from-to)837-842
Number of pages6
JournalCirculation
Volume109
Issue number7
DOIs
StatePublished - Feb 24 2004
Externally publishedYes

Fingerprint

1-Alkyl-2-acetylglycerophosphocholine Esterase
C-Reactive Protein
Coronary Disease
Atherosclerosis
Type C Phospholipases
LDL Cholesterol
Community-Institutional Relations
LDL Lipoproteins
Proportional Hazards Models
Cohort Studies

Keywords

  • Coronary disease
  • Epidemiology
  • Inflammation
  • Risk factors

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine

Cite this

Lipoprotein-Associated Phospholipase A2, High-Sensitivity C-Reactive Protein, and Risk for Incident Coronary Heart Disease in Middle-Aged Men and Women in the Atherosclerosis Risk in Communities (ARIC) Study. / Ballantyne, Christie M.; Hoogeveen, Ron C.; Bang, Heejung; Coresh, Josef; Folsom, Aaron R.; Heiss, Gerardo; Sharrett, A. Richey.

In: Circulation, Vol. 109, No. 7, 24.02.2004, p. 837-842.

Research output: Contribution to journalArticle

Ballantyne, Christie M. ; Hoogeveen, Ron C. ; Bang, Heejung ; Coresh, Josef ; Folsom, Aaron R. ; Heiss, Gerardo ; Sharrett, A. Richey. / Lipoprotein-Associated Phospholipase A2, High-Sensitivity C-Reactive Protein, and Risk for Incident Coronary Heart Disease in Middle-Aged Men and Women in the Atherosclerosis Risk in Communities (ARIC) Study. In: Circulation. 2004 ; Vol. 109, No. 7. pp. 837-842.
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abstract = "Background-Measuring C-reactive protein (CRP) has been recommended to identify patients at high risk for coronary heart disease (CHD) with low LDL cholesterol (LDL-C). Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a proinflammatory enzyme associated primarily with LDL. Methods and Results-In a prospective, case cohort study in 12 819 apparently healthy middle-aged men and women in the Atherosclerosis Risk in Communities study, the relation between Lp-PLA2, CRP, traditional risk factors, and risk for CHD events over a period of ≈6 years was examined in a proportional hazards model, stratified by LDL-C. Lp-PLA2 and CRP levels were higher in the 608 cases than the 740 noncases. Both Lp-PLA 2 and CRP were associated with incident CHD after adjustment for age, sex, and race with a hazard ratio of 1.78 for the highest tertile of Lp-PLA2 and 2.53 for the highest category of CRP versus the lowest categories. Lp-PLA2 correlated positively with LDL-C (r=0.36) and negatively with HDL-C (r= -0.33) but not with CRP (r= -0.05). In a model adjusted for traditional risk factors including LDL-C, the association of Lp-PLA2 with CHD was attenuated and not statistically significant. For individuals with LDL-C below the median (130 mg/dL), Lp-PLA2 and CRP were both significantly and independently associated with CHD in fully adjusted models. For individuals with LDL-C < 130 mg/dL, those with both Lp-PLA2 and CRP levels in the highest tertile were at the greatest risk for a CHD event. Conclusions-Lp-PLA2 and CRP may be complementary in identifying individuals at high CHD risk who have low LDL-C.",
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AU - Ballantyne, Christie M.

AU - Hoogeveen, Ron C.

AU - Bang, Heejung

AU - Coresh, Josef

AU - Folsom, Aaron R.

AU - Heiss, Gerardo

AU - Sharrett, A. Richey

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AB - Background-Measuring C-reactive protein (CRP) has been recommended to identify patients at high risk for coronary heart disease (CHD) with low LDL cholesterol (LDL-C). Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a proinflammatory enzyme associated primarily with LDL. Methods and Results-In a prospective, case cohort study in 12 819 apparently healthy middle-aged men and women in the Atherosclerosis Risk in Communities study, the relation between Lp-PLA2, CRP, traditional risk factors, and risk for CHD events over a period of ≈6 years was examined in a proportional hazards model, stratified by LDL-C. Lp-PLA2 and CRP levels were higher in the 608 cases than the 740 noncases. Both Lp-PLA 2 and CRP were associated with incident CHD after adjustment for age, sex, and race with a hazard ratio of 1.78 for the highest tertile of Lp-PLA2 and 2.53 for the highest category of CRP versus the lowest categories. Lp-PLA2 correlated positively with LDL-C (r=0.36) and negatively with HDL-C (r= -0.33) but not with CRP (r= -0.05). In a model adjusted for traditional risk factors including LDL-C, the association of Lp-PLA2 with CHD was attenuated and not statistically significant. For individuals with LDL-C below the median (130 mg/dL), Lp-PLA2 and CRP were both significantly and independently associated with CHD in fully adjusted models. For individuals with LDL-C < 130 mg/dL, those with both Lp-PLA2 and CRP levels in the highest tertile were at the greatest risk for a CHD event. Conclusions-Lp-PLA2 and CRP may be complementary in identifying individuals at high CHD risk who have low LDL-C.

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