ORIGINAL ARTICLEAssociation Between Lipoprotein-Associated Phospholipase A2 and Cardiovascular Disease: A Systematic Review
Section snippets
Selection Criteria
Eligible studies were case-control studies alone or nested in cohort studies and cohort studies with at least 1 year of follow-up that measured CVD risk in terms of blood levels of Lp-PLA2 and were published in English. We excluded studies that reported on the association between Lp-PLA2 and stable angina alone and studies with fewer than 50 participants.
Literature Search
We searched MEDLINE (January 1, 1985, through September 30, 2006), the Cochrane library (from inception through September 2006), conference
RESULTS
Computerized and hand searches identified 119 articles and abstracts. Of these, we retrieved 28 for closer evaluation and selected 12 full-length articles and 2 abstracts for inclusion (Figure 1). One potentially eligible study was excluded because Lp-PLA2 was measured at baseline and 30 days after, reporting 2 different risk estimates.18 After an exhaustive search for unpublished data, none of the investigators in the field who were contacted were aware of unpublished studies. Table 1 gives
DISCUSSION
The results of this systematic review support an association between elevated blood levels of Lp-PLA2 and increasedCVD risk. The measure of association chosen (either hazard ratio or relative risk vs odds ratio) and the methods used to report results (extreme percentiles vs ≥1-SD change from mean) explained the inconsistency in results across studies. Among the studies included in the meta-analysis, 2 did not show a significant association between Lp-PLA2 and CVD. The negative results of the
CONCLUSION
Lipoprotein-associated phospholipase A2 is significantly associated with CVD, with only limited influence of conventional CVD risk factors on this relationship. In addition, Lp-PLA2 may be useful in CVD risk stratification and may represent a therapeutic target for cardiovascular risk reduction.
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Dr Somers is supported by National Institutes of Health grants HL65176, HL61560, HL 70302, and M01-RR00585. Dr Kullo is supported by National Institutes of Health grant HL-813301. Dr Lopez-Jimenez is a recipient of a Clinical Scientist Development Award from the American Heart Association.