Abstract
BackgroundLipoprotein-associated phospholipase A2 (Lp-PLA2) is a predictor of cardiovascular events that has been shown to vary with race. The objective of this study was to examine factors associated with this racial variation.MethodsWe measured Lp-PLA2 mass and activity in 714 healthy older adults with no clinical coronary heart disease and not taking dyslipidemia medication. We evaluated the association between race and Lp-PLA2 mass and activity levels after adjustment for various covariates using multivariable linear regression. These covariates included age, sex, diabetes, hypertension, body mass index, lipid measurements, C-reactive protein, smoking status, physical activity, diet, income, and education level. We further examined genetic covariates that included three single nucleotide polymorphisms shown to be associated with Lp-PLA2 activity levels.ResultsThe mean age was 66 years. Whites had the highest Lp-PLA2 mass and activity levels, followed by Hispanics and Asians, and then African-Americans; in age and sex adjusted analyses, these differences were significant for each non-White race as compared to Whites (p < 0.0001). For example, African-Americans were predicted to have a 55.0 ng/ml lower Lp-PLA2 mass and 24.7 nmol/ml-min lower activity, compared with Whites, independent of age and sex (p < 0.0001). After adjustment for all covariates, race remained significantly correlated with Lp-PLA2 mass and activity levels (p < 0.001) with African-Americans having 44.8 ng/ml lower Lp-PLA2 mass and 17.3 nmol/ml-min lower activity compared with Whites (p < 0.0001).ConclusionBiological, lifestyle, demographic, and select genetic factors do not appear to explain variations in Lp-PLA2 mass and activity levels between Whites and non-Whites, suggesting that Lp-PLA2 mass and activity levels may need to be interpreted differently for various races.
Highlights
Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a predictor of cardiovascular events that has been shown to vary with race
The study population consisted of 540 whites, 60 African-Americans, 62 Hispanics, and 52 Asians (Table 1)
Hispanics were the most likely to have the Arg92His single nucleotide polymorphisms (SNPs), while African-Americans were the most likely to have the Ile198Thr SNP compared to Whites
Summary
Lipoprotein-associated phospholipase A2 (Lp-PLA2) is a predictor of cardiovascular events that has been shown to vary with race. The objective of this study was to examine factors associated with this racial variation. Lipoprotein-associated phospholipase A2 (Lp-PLA2) circulates in the blood as an enzyme bound mainly to low-density lipoprotein (LDL) particles. Lp-PLA2 has been found in multiple studies to be associated with incident and prevalent coronary heart disease (CHD) [1,2,3,4,5,6] and incident stroke,[5,7] independent of standard cardiovascular risk factors[8]. A collaborative metaanalysis of 32 prospective studies in 79,000 patients showed that both Lp-PLA2 mass and activity added predictive value for vascular events and mortality
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