Lipoprotein-Associated and Secretory Phospholipase A2 in Cardiovascular Disease: The Epidemiological Evidence

Among other lipid related biomarkers, lipoprotein-associated phospholipase A(2) (Lp-PLA(2)) and type II secretory phospholipase A(2) (sPLA(2)) represent emerging candidates for refined assessment of future cardiovascular disease (CVD) risk. Indeed, emerging evidence from more than prospective 15 studies conducted since 2000, clearly demonstrate the prognostic ability of increased Lp-PLA(2) concentrations or elevated activity for risk of future coronary heart disease (CHD) and stroke. Moreover, Lp-PLA(2) might have similar predictive power for both, incident CHD in initially healthy subjects, as well as for recurrent events in those with clinically manifest atherosclerosis. By contrast, to date, there are only few prospective studies that have investigated the relationship of sPLA(2) with future CVD risk. However, most of them show a positive association between increased mass or elevated activity and future atherosclerotic complications. Nonetheless, since inhibitors of Lp-PLA(2) and sPLA(2) have already been developed, these enzymes may be considered as novel therapeutic targets to treat residual risk in certain high risk patient groups. This review summarizes the epidemiologic evidence on the association between increased mass or elevated activity of these two phospholipases and risk of CVD.