Effects of lifestyle counseling and combination lipid-modifying therapy on lipoprotein-associated phospholipase A2 mass concentration

Background Lipoprotein-associated phospholipase A2 (Lp-PLA 2 ) is a novel inflammatory biomarker that is associated with increased cardiovascular disease risk independent of and additive to traditional risk factors. Lp-PLA 2 activity is correlated with the degree of inflammation in the atherosclerotic plaque. In human blood, approximately 80% of Lp-PLA 2 is associated with low-density lipoproteins (LDL). Thus, it is hypothesized that changes in Lp-PLA 2 should imitate the changes in the LDL cholesterol. Objective In this present study, we examined the efficacy of lifestyle intervention and combination lipid-lowering therapy on reducing the Lp-PLA 2 levels and determined the relationship between changes in LDL-C and Lp-PLA 2 . Methods This retrospective chart review study includes two hundred forty eight patients (58% men and 42% women) who completed the life style intervention in combination with pharmacologic therapy for an average period of 10.5 months. Life style modification included diet and exercise counseling. Combination therapy included omega 3 fish oil (2000mg/d), extended-release niacin (500-1000mg/d), ezetimibe (10mg/d), fenofibrate 160mg/d and colesevelam HCI (1850mg/d), as well as statins. The statins used were either simvastatin (20-40mg/d) or rosuvastatin (5–20mg/d). Sixty five percent (n=161) received low to medium doses of simvastatin, whereas 35% (n=87) received low to medium doses of rosuvastatin. Results The study revealed a 32.5% reduction in mean Lp-PLA 2 values (baseline 181.1±41.5 vs 122.1±28.1 ng/mL after treatment; P P 2 and LDL-C (r 2 =0.052, P Conclusion Lp-PLA 2 is reduced with the use of life style counseling and combination lipid lowering therapy. Results also revealed that changes in Lp-PLA 2 may be partially explained by the changes in LDL-C.