Lipoprotein-associated phospholipase A2, platelet-activating factor acetylhydrolase: a potential new risk factor for coronary artery disease

A specific and robust immunoassay for the lipoprotein-associated phospholipase A2 (Lp-PLA2), platelet-activating factor acetylhydrolase, is described for the first time. The immunoassay was used to evaluate possible links between plasma Lp-PLA2 levels and atherosclerosis risk amongst susceptible individuals. Such an investigation was important because Lp-PLA2 participates in the oxidative modification of low density lipoprotein by cleaving oxidised phosphatidylcholines, generating lysophosphatidylcholine and oxidised free fatty acids. The majority of Lp-PLA2 was found associated with LDL (approximately 80%) and, as expected, enzyme levels were significantly positively correlated to LDL cholesterol. Plasma Lp-PLA2 levels were significantly elevated in patients with angiographically proven coronary artery disease (CAD) when compared with age-matched controls, even though LDL cholesterol levels did not differ significantly. Indeed, when included in a general linear model with LDL cholesterol and other risk factors, Lp-PLA2 appeared to be an independent predictor of disease status. We propose, therefore, that plasma Lp-PLA2 mass should be viewed as a potential novel risk factor for CAD that provides information related to but additional to traditional lipoprotein measurements.