Circulating Lipoprotein-associated Phospholipase A2 in High-grade Carotid Stenosis: A New Biomarker for Predicting Unstable Plaque

ObjectiveTo test plasma levels of lipoprotein-associated phospholipase A2 (Lp-PLA2) in patients with high-grade carotid stenosis according to plaque histology.MethodsThis cross-sectional single-centre study included patients with ≥70% North American Symptomatic Carotid Endarterectomy Trial (NASCET) carotid stenosis, who were treated surgically. Serum Lp-PLA2 and high-sensitivity C-reactive protein (hs-CRP) were determined on the day of surgery. Histopathological analysis classified carotid plaque as stable or unstable, according to AHA classification.ResultsOf the 42 patients (mean age 70.4 ± 10.5 years; 67% men), neurological symptoms were present in 16 (38%). Unstable plaques were found in 23 (55%). Median plasma level of Lp-PLA2 was significantly higher in patients with unstable plaque compared to those with stable plaque (222.4 (174.9–437.5) interquartile range (IQR) 63.5 vs. 211.1 (174.9–270.6) IQR 37.2 ng ml−1; p = 0.02). Moreover, median Lp-PLA2 level were higher in asymptomatic patients with unstable plaque (226.8 ng ml−1 (174.9–437.5) IQR 76.8) vs. stable plaque (206.9 ng ml−1 (174.9–270.6) IQR 33.7; p = 0.16). Logistic regression showed that only the neurological symptoms (OR = 30.9 (3.7–244.6); p < 0.001) and the plasma Lp-PLA2 level (OR = 1.7 (1.1–12.3); p = 0.03) were independently associated with unstable carotid plaque as defined by histology.ConclusionsThis study showed that circulating Lp-PLA2 was increased in patients with high-grade carotid stenosis and unstable plaque. Lp-PLA2 may be a relevant biomarker to guide for invasive therapy in asymptomatic patients with carotid artery disease.