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Systematic Review of the Association between Lipoprotein-Associated Phospholipase
A2 and Atherosclerosis
#MMPMID26339459
Liu J
; Hong Y
; Qi Y
; Zhao F
; Zhao D
N Am J Med Sci (Boston)
2011[Oct]; 4
(4
): 201-211
PMID26339459
show ga
Lipoprotein-associated phospholipase A2 (Lp-PLA(2)) is a novel inflammatory
biomarker. Basic research has shown that Lp-PLA(2) is involved in the
pathogenesis of atherosclerosis. In the past decade, an increasing number of
epidemiological studies have investigated the association of Lp-PLA(2) 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-PLA(2) and atherosclerotic cardiovascular disease
(CVD)/subclinical atherosclerosis, we tried to evaluate the relationship between
Lp-PLA(2) 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-PLA(2) 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-PLA(2) 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-PLA(2) 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-PLA(2) and CVD, among which 31 showed that increased
Lp-PLA(2) 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-PLA(2) and subclinical
atherosclerosis; among them, two studies demonstrated that Lp-PLA(2) was
associated with coronary artery calcification in young adults and men. In
conclusion, many epidemiological studies have demonstrated that Lp-PLA(2)
increases the risk of clinical CVD events. However, whether there is a similar
association between Lp-PLA(2) and subclinical atherosclerosis remains unclear.
Whether Lp-PLA(2) 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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