Faculty Collaboration Database

Lipoprotein-associated phospholipase A2 predicts progression of cardiac allograft vasculopathy and increased risk of cardiovascular events in heart transplant patients. Transplantation 2008 Apr 15;85(7):963-8

Date

04/15/2008

Pubmed ID

18408575

Pubmed Central ID

PMC3942087

DOI

10.1097/TP.0b013e3181684319

Scopus ID

2-s2.0-42149109624 (requires institutional sign-in at Scopus site)   17 Citations

Abstract

BACKGROUND: Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a risk factor for coronary artery disease (CAD) in nontransplant patients. We evaluated the association between Lp-PLA2, cardiac allograft vasculopathy (CAV) assessed by 3D intravascular ultrasound, and incidence of cardiac adverse events in heart transplant recipients.

MATERIALS AND METHODS: Fasting blood samples were obtained and stored from a cross-section of 112 cardiac transplant recipients attending the Mayo cardiac transplant clinic in 2000 to 2001, mean of 4.7 years after transplant. Lp-PLA2 was measured in plasma aliquots using an enzyme-linked immunoassay. Fifty-six of these patients subsequently underwent two 3D intravascular ultrasound studies in 2004 to 2006 12 months apart. Cardiovascular (CV) events included percutaneous coronary intervention, coronary artery bypass grafting (CABG), reduction in left ventricular ejection fraction (LVEF) < or =45% secondary to CAV and CV death.

RESULTS: High Lp-PLA2 level was associated with increase in plaque volume (r=0.43, P=0.0026) and percent plaque volume (r=0.45, P=0.0004). The association remained significant after adjusting for clinical and lipid variables. During follow-up of 5.1+/-1.6 years, 24 CV adverse events occurred in 15 of 112 (13%) heart transplant patients. Lp-PLA2 level>236 ng/mL (higher tertile) identified a subgroup of patients having a 2.4-fold increase of relative risk for combined endpoint of CV events (percutaneous coronary intervention, CABG, LVEF<45%, and CV death; 95% CI 1.16-5.19, P=0.012) compared with patients with Lp-PLA2< or =236 ng/mL.

CONCLUSIONS: Lp-PLA2 is independently associated with progression of CAV and predicts a higher incidence of CV events and CV death in transplant patients. This finding supports the concept that systemic inflammation is an important mediator of CAV. Lp-PLA2 may be a useful marker for risk of CAV and a therapeutic target in posttransplant patients.

Author List

Raichlin E, McConnell JP, Bae JH, Kremers WK, Lerman A, Frantz RP

Author

Eugenia Raichlin MD Professor in the Medicine department at Medical College of Wisconsin

MESH terms used to index this publication - Major topics in bold

1-Alkyl-2-acetylglycerophosphocholine Esterase
Adult
Analysis of Variance
Cardiovascular Diseases
Cholesterol, HDL
Cholesterol, LDL
Coronary Disease
Disease Progression
Female
Heart Transplantation
Humans
Lipids
Male
Middle Aged
Postoperative Complications
Risk Factors
Sex Characteristics
Time Factors
Transplantation, Homologous