The use of suitable biomarkers to enhance risk stratification of those at intermediate risk from global risk assessment for cardiovascular disease has an important role, since a large proportion of all cardiovascular events occur among those at intermediate risk.

Lipoprotein associated phospholipase A2 (Lp-PLA₂) is a novel biomarker of oxidation and inflammation that has recently emerged as a predictor of risk in the clinical setting. It was found to be an independent risk factor for coronary heart disease in men with hypercholesterolemia who were enrolled in the West of Scotland Coronary Prevention Study (1). Since then a number of studies have provided data on the predictive ability of Lp-PLA₂ and high-sensitivity C-reactive protein (hsCRP) in apparently healthy individuals, in patients with stable coronary artery disease, and in patients with acute coronary syndromes.

The use of hsCRP is supported by guidelines from the American Heart Association and Centers for Disease Control, as part of global coronary risk assessment in adults without known cardiovascular disease (2), however the primary prevention data for Lp-PLA₂ appear to be inconsistent. Unlike hsCRP, Lp-PLA₂ appears to correlate with low-density lipoprotein cholesterol (LDL-C), bringing into question its usefulness beyond that of measuring LDL-C. Lp-PLA₂-lowering by statin treatment was found to be related to LDL-C reduction (3).

Dr. Ridker discusses in more detail the relevant study results, some practical issues with biomarker measurement, and the role for biomarker use as part of global risk assessment.

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After viewing this presentation the participant will be able to discuss:

Why do novel risk markers matter?
Clinical attributes of hsCRP and Lp-PLA₂

1. Chris J. Packard et al.Lipoprotein-Associated Phospholipase A2 as an Independent Predictor of Coronary Heart Disease NEJM 2000;Volume 343:1148-1155.

2. Thomas A. Pearson et al. Markers of Inflammation and Cardiovascular Disease: Application to Clinical and Public Health Practice: A Statement for Healthcare Professionals From the Centers for Disease Control and Prevention and the American Heart Association Circulation. 2003;107:499.

3. Albert MA et al. The effect of statin therapy on lipoprotein associated phospholipase A2 levels Atherosclerosis Volume 182, Issue 1, September 2005, Pages 193-198.