Published Online
on June 19, 2009

A more recent version of this article appeared on September 1, 2009

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Original Article

Lipoprotein-Associated Phospholipase A₂ and Risk of Congestive Heart Failure in Older Adults: the Cardiovascular Health Study

Takeki Suzuki¹; Cam Solomon²; Nancy Swords Jenny¹; Russell Tracy¹; Jeanenne J. Nelson³; Bruce M. Psaty²; Curt Furberg⁴ and Mary Cushman^1,5

¹ University of Vermont, Burlington, VT;
² University of Washington, Seattle, WA;
³ GlaxoSmithKline, Research Triangle Park, NC;
⁴ Wake Forest University, Winston-Salem, NC

⁵ E-mail: mary.cushman{at}uvm.edu

Background—Inflammation may be an etiologic factor in congestive heart failure (CHF). Lipoprotein associated phospholipase A₂ (Lp-PLA₂) is an inflammation marker associated with vascular risk. One previous study showed an association of Lp-PLA₂ activity with CHF risk, but there were only 94 CHF cases and Lp-PLA₂ antigen, which is available clinically in the US, was not measured.

Methods and Results—We measured baseline Lp-PLA₂ antigen and activity in 3991 men and women without baseline CHF or cardiovascular disease, participating in the Cardiovascular Health Study, a prospective observational study of adults 65 years old. Cox proportional hazards models adjusted for age, sex, clinic site, race, LDL and HDL cholesterol, body-mass index, systolic and diastolic blood pressure, hypertension, smoking status, pack-years and diabetes were used to calculate hazard ratios (HRs) and 95% confidence intervals (CIs) for incident CHF. Further models adjusted for coronary disease events during follow up and C-reactive protein (CRP). 829 participants developed CHF over 12.1 years. Adjusted HRs for CHF with Lp-PLA₂ in the fourth compared to first quartile, were 1.44 (CI 1.16-1.79) for Lp-PLA₂ antigen and 1.06 (CI 0.84-1.32) for activity. Adjustment for incident coronary disease attenuated the HR for Lp-PLA₂ antigen to 1.26 (CI 1.02-1.57), adjustment for CRP had minimal impact.

Conclusion—Lp-PLA₂ antigen was associated with risk of future CHF in older people, independent of CHF and coronary risk factors, and partly mediated by coronary disease events. Further clinical and basic research is needed to better understand the role of Lp-PLA₂ in CHF.

Key Words: epidemiology • heart failure