Plasma lipoprotein-associated phospholipase A2 levels in heart failure: Association with mortality in the community

ObjectiveLipoprotein-associated phospholipase A2 (Lp-PLA2) is a useful inflammatory marker of cardiovascular risk, yet little is known of its prognostic role in heart failure (HF). We evaluated the association of Lp-PLA2 with mortality in subjects with HF and assessed its incremental value for risk discrimination over established risk factors and biomarkers.MethodsResidents of Olmsted County, MN, diagnosed with HF between September 2003 and April 2007 (n = 646, mean age 76 years, 51% women) were prospectively enrolled and followed-up. Plasma Lp-PLA2 levels were measured at baseline and evaluated along with known risk indicators.ResultsLp-PLA2 was positively associated with male gender and low-density lipoprotein cholesterol and inversely associated with statin use and diabetes. During follow-up (median 21 months), 213 deaths occurred. Elevated Lp-PLA2 was associated with an increased risk of mortality (hazard ratio (HR) = 1.57; 95% confidence interval (CI): 1.03–2.37; P = 0.035, per 1-unit increase in the log-transformed values). The relationship differed markedly by age (Pinteraction = 0.003), with a strong association in patients under 80 years (covariate-adjusted HR = 3.83; 95% CI: 1.93–7.61; P < 0.001) and none in older ones (covariate-adjusted HR = 0.82; 95% CI: 0.44–1.51; P = 0.55). For the younger subjects, an improvement in the model's discriminatory power was obtained by adding Lp-PLA2 to established risk indicators and biomarkers (area under the receiver operating characteristic curve, 0.709–0.744, Pdifference = 0.008).ConclusionIn this community-based cohort of patients with HF, Lp-PLA2 was strongly and independently associated with mortality and contributed incrementally to risk discrimination in patients under 80 years of age.