Lipoprotein‐Associated Phospholipase A2 Activity Is a Marker of Risk But Not a Useful Target for Treatment in Patients With Stable Coronary Heart Disease

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Wallentin, Lars
Held, Claes
Armstrong, Paul W.
Davies, Richard Y.
Granger, Christopher B.
Hagström, Emil
Harrington, Robert A.
Hochman, Judith S.
Koenig, Wolfgang
Krug‐Gourley, Sue
Mohler, Emile R.
Siegbahn, Agneta
Tarka, Elizabeth
Steg, Philippe Gabriel
Stewart, Ralph A. H.
Weiss, Robert
Östlund, Ollie
White, Harvey D.
Budaj, Andrzej
Ardissino, Diego
Avezum, Alvaro
Aylward, Philip E.
Bryce, Alfonso
Chen, Hong
Chen, Ming‐Fong
Corbalan, Ramon
Dalby, Anthony J.
Danchin, Nicolas
De Winter, Robbert J.
Denchev, Stefan
Diaz, Rafael
Elisaf, Moses
Flather, Marcus D.
Goudev, Assen R.
Grinfeld, Liliana
Husted, Steen
Kim, Hyo‐Soo
Linhart, Ales
Lonn, Eva
López‐Sendón, José
Manolis, Athanasios J.
Nicolau, José C.
Pais, Prem
Parkhomenko, Alexander
Pedersen, Terje R.
Pella, Daniel
Ramos‐Corrales, Marco A.
Ruda, Mikhail
Sereg, Mátyás
Siddique, Saulat
Sinnaeve, Peter
Sritara, Piyamitr
Swart, Henk P.
Sy, Rody G.
Teramoto, Tamio
Tse, Hung‐Fat
Weaver, W. Douglas
Viigimaa, Margus
Vinereanu, Dragos
Zhu, Junren
Note: Order does not necessarily reflect citation order of authors.
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https://doi.org/10.1161/JAHA.116.003407Metadata
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Wallentin, L., C. Held, P. W. Armstrong, C. P. Cannon, R. Y. Davies, C. B. Granger, E. Hagström, et al. 2016. “Lipoprotein‐Associated Phospholipase A2 Activity Is a Marker of Risk But Not a Useful Target for Treatment in Patients With Stable Coronary Heart Disease.” Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease 5 (6): e003407. doi:10.1161/JAHA.116.003407. http://dx.doi.org/10.1161/JAHA.116.003407.Abstract
Background: We evaluated lipoprotein‐associated phospholipase A2 (Lp‐PLA 2) activity in patients with stable coronary heart disease before and during treatment with darapladib, a selective Lp‐PLA 2 inhibitor, in relation to outcomes and the effects of darapladib in the STABILITY trial. Methods and Results: Plasma Lp‐PLA 2 activity was determined at baseline (n=14 500); at 1 month (n=13 709); serially (n=100) at 3, 6, and 18 months; and at the end of treatment. Adjusted Cox regression models evaluated associations between Lp‐PLA 2 activity levels and outcomes. At baseline, the median Lp‐PLA 2 level was 172.4 μmol/min per liter (interquartile range 143.1–204.2 μmol/min per liter). Comparing the highest and lowest Lp‐PLA 2 quartile groups, the hazard ratios were 1.50 (95% CI 1.23–1.82) for the primary composite end point (cardiovascular death, myocardial infarction, or stroke), 1.95 (95% CI 1.29–2.93) for hospitalization for heart failure, 1.42 (1.07–1.89) for cardiovascular death, and 1.37 (1.03–1.81) for myocardial infarction after adjustment for baseline characteristics, standard laboratory variables, and other prognostic biomarkers. Treatment with darapladib led to a ≈65% persistent reduction in median Lp‐PLA 2 activity. There were no associations between on‐treatment Lp‐PLA 2 activity or changes of Lp‐PLA 2 activity and outcomes, and there were no significant interactions between baseline and on‐treatment Lp‐PLA 2 activity or changes in Lp‐PLA 2 activity levels and the effects of darapladib on outcomes. Conclusions: Although high Lp‐PLA 2 activity was associated with increased risk of cardiovascular events, pharmacological lowering of Lp‐PLA 2 activity by ≈65% did not significantly reduce cardiovascular events in patients with stable coronary heart disease, regardless of the baseline level or the magnitude of change of Lp‐PLA 2 activity. Clinical Trial Registration URL: https://www.clinicaltrials.gov. Unique identifier: NCT00799903.Other Sources
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4937279/pdf/Terms of Use
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