Lipoprotein-Associated Phospholipase A2 Activity Is Associated with Large-Artery Atherosclerotic Etiology and Recurrent Stroke in TIA Patients

Abstract

Background: Lipoprotein-associated phospholipase A₂ (Lp-PLA₂) has emerged as a novel biomarker in cardiovascular diseases due to its ability to predict stroke in population-based studies. We aimed to investigate Lp-PLA₂ levels in transient ischemic attack (TIA) patients and to study their relationship with stroke recurrence. Methods: Lp-PLA₂ mass and activity were measured by means of the PLAC test with an automated Olympus analyzer and by a colorimetric activity method (diaDexus) in 166 TIA patients and 144 healthy controls. Vascular risk factors and stroke etiology were assessed. Outcome was defined as the presence of recurrent stroke/TIA within 7 and 30 days after the index TIA. Multivariate analyses were performed to identify potential predictors of recurrence. Results: Both Lp-PLA₂ mass and activity (p < 0.05) were higher in TIA than in controls. Several risk factors or previous treatments were associated with Lp-PLA₂ mass and activity level. During follow-up, 20 strokes/TIA (12%) occurred within the first 30 days and the presence of a large-artery atherosclerosis etiology of stroke (HR 3.28, p = 0.011), together with the past medical history of hyperlipidemia (HR 3.68, p = 0.008) and Lp-PLA₂ activity of >207 nmol/ml/min (HR 2.7, p = 0.042) were all significant predictors for recurrent stroke/TIA. Conclusions: Lp-PLA₂ activity might add significant prognostic information in the early evaluation of TIA patients.