Lipoprotein-associated phospholipase A2 is an enzyme that causes hydrolysis of oxidized LDL in the intima of the artery. This process generates pro-inflammatory mediators and a variety of inflammatory stimuli that are associated with atherosclerosis. Elevated circulating Lp-PLA₂ is a specific marker for vascular inflammation, playing a causal role in the vascular inflammatory process which leads to the formation of vulnerable, rupture-prone plaque. Elevated levels have been shown to be powerful predictors of ischemic stroke and heart attack risk.

Clinical Implications:

High Lp-PLA₂ levels indicate that plaque has progressed to a vulnerable state and may be prone to rupture. Elevated Lp-PLA₂ levels have been associated with a two-fold increased risk for cardiovascular events and more than a five-fold increased risk for stroke events. When CRP is also elevated, the Lp-PLA₂-associated risk for cardiovascular disease (CVD) or stroke events doubles again. The risk for CVD events rises sharply when Lp-PLA₂ exceeds 223 ng/ml.

Treatment considerations:

• Common first-line pharmacological considerations:
  • Statins
• Additional pharmacological considerations:
  • Fenofibrates
  • Nicotinic acid
• Lifestyle changes:
  • Nutrition and exercise

For more information and detailed references, please refer to our Clinical Implications Reference Manual.