Relationships between the levels of lipoprotein-associated phospholipase A2 and the risk of cardiovascular events, evaluation of efficacy of preventive therapy with statins

Aim. The purpose of the study was to elucidate the relationships between the levels of lipoprotein-associated phospholipase A2 (LP-PLA2), and the risk of cardiovascular events and to evaluate the efficacy of preventive therapy with statins. The study comprised a total of 60 patients with coronary artery disease (CAD) associated with type 2 diabetes mellitus who underwent endovascular revascularization. The twelve-month follow-up study documented the following events: death, myocardial infarction (MI), acute cerebrovascular event, repeated coronary revascularization, and recurrence of angina. Patients were assigned to two groups based on the absence or the presence of end points: group 1 comprised patients with unfavorable course of disease (n=30); group 2 comprised patients with favorable course (n=30). In all patients, the study determined parameters of LP-PLA2, glycemic profile, glycated hemoglobin, insulin, Apo-B, Apo-A1, Lp (a), and lipid profile. Homeostasis model assessment (HOMA) of insulin resistance was determined. All patients received atorvastatin at a dose of 20-40 mg/day. The 12-month follow-up study showed that, in the presence of atorvastatin therapy at a dose of 30 mg/day in group 1, the levels of total cholesterol (TC), triglycerides (TG), and low-density lipoprotein (LDL) cholesterol decreased by 20.71%, 26.21%, and 25.84%, respectively. In group 2, TC decreased by 30.52%, LDL cholesterol decreased by 31.41%, and Apo-B decreased by 45.2%. The LP-PLA2 levels decreased by 21.28% and 26.63% in group 1 and in group 2, respectively (р=0.004). In group 1, one patient died (3.3%). Angina reoccurred in 96.7% of subjects. Based on coronary angiography data, 16.7% of patients had stent restenosis; 63.3% of patients had progression of atherosclerosis. Myocardial infarction and acute cerebrovascular event reoccurred in 10% and 3.3% of patients, respectively. Repeated revascularization was performed in 70% of patients. LP-PLA2 level may be considered a prognostic marker of unfavorable cardiovascular events in patients with CAD associated with type 2 diabetes mellitus allowing for selection of special patient cohort for more aggressive lipid correction therapy aimed at achieving target level of LDL cholesterol.