Lipoprotein-associated phospholipase A2 activity improves risk discrimination of incident coronary heart disease among women

Am Heart J. 2011 Mar;161(3):516-22. doi: 10.1016/j.ahj.2010.11.007. Epub 2011 Jan 31.


Background: This study sought to determine the relation between and discriminative capability of lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and coronary heart disease (CHD) in a large population of disease-free women.

Methods: Among participants of the Nurses' Health Study who provided a blood sample, there were 421 cases of incident myocardial infarction during 14 years of follow-up. Controls were matched to cases 2:1 using risk set sampling based on age, smoking, and blood draw date.

Results: After conditioning on the matching factors, Lp-PLA(2) activity was significantly associated with myocardial infarction (relative risk [RR] 2.86 for extreme quartiles, 95% CI 1.98-4.12). Upon additional adjustment for lipid, inflammatory, and clinical risk factors, the RR remained statistically significant (RR 1.75, 95% CI 1.09-2.84). The discriminative capability of Lp-PLA(2) was assessed by comparing the area below the receiver operating characteristic curves for models with and without Lp-PLA(2) and by calculating the net reclassification improvement index. The addition of Lp-PLA(2) activity to a multivariable-adjusted model increased the receiver operating characteristic curves from 0.720 to 0.733 and significantly improved the net reclassification improvement index (P = .004).

Conclusions: Levels of Lp-PLA(2) activity were significantly associated with incident CHD among women. In addition, Lp-PLA(2) activity added significantly to CHD risk discrimination.

MeSH terms

  • 1-Alkyl-2-acetylglycerophosphocholine Esterase / metabolism*
  • Adult
  • Case-Control Studies
  • Coronary Disease / enzymology*
  • Coronary Disease / epidemiology
  • Female
  • Humans
  • Life Style
  • Logistic Models
  • Middle Aged
  • Multivariate Analysis
  • ROC Curve
  • Risk Assessment


  • 1-Alkyl-2-acetylglycerophosphocholine Esterase