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

Reddy, Kota J.; Singh, Manmeet; Batsell, Richard R.; Bangit, Joey R.; Miraskar, Rekha A.; Zaheer, Misbah S.; Cockerham, Carol; Wegner, Michael

doi:10.1016/j.jacl.2009.06.004

« Previous Next »Journal of Clinical Lipidology
Volume 3, Issue 4 , Pages 275-280, August 2009

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

Kota J. Reddy, MD
- Reddy Cardiac Wellness, Cardiology, 3519 Town Center BLVD, Suite A, Sugar Land, TX, USA
Manmeet Singh, MD
- Reddy Cardiac Wellness, Cardiology, 3519 Town Center BLVD, Suite A, Sugar Land, TX, USA
- Corresponding author.
Richard R. Batsell, PhD
- Rice University, Houston, TX, USA
Joey R. Bangit, MD
- Reddy Cardiac Wellness, Cardiology, 3519 Town Center BLVD, Suite A, Sugar Land, TX, USA
Rekha A. Miraskar, MD
- Reddy Cardiac Wellness, Cardiology, 3519 Town Center BLVD, Suite A, Sugar Land, TX, USA
Misbah S. Zaheer, MD
- Reddy Cardiac Wellness, Cardiology, 3519 Town Center BLVD, Suite A, Sugar Land, TX, USA
Carol Cockerham, MS
- Reddy Cardiac Wellness, Cardiology, 3519 Town Center BLVD, Suite A, Sugar Land, TX, USA
Michael Wegner, PhD
- diaDexus Inc, San Francisco, CA, USA

Received 18 March 2009; accepted 26 June 2009. published online 06 July 2009.

Background

Lipoprotein-associated phospholipase A2 (Lp-PLA₂) is a novel inflammatory biomarker that is associated with increased cardiovascular disease risk independent of and additive to traditional risk factors. Lp-PLA₂ activity is correlated with the degree of inflammation in the atherosclerotic plaque. In human blood, approximately 80% of Lp-PLA₂ is associated with low-density lipoproteins (LDL). Thus, it is hypothesized that changes in Lp-PLA₂ 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-PLA₂ levels and determined the relationship between changes in LDL-C and Lp-PLA₂.

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-PLA₂ values (baseline 181.1±41.5 vs 122.1±28.1 ng/mL after treatment; P<.001). The change observed in LDL-C was 41%, (baseline 126.2±43 vs 73.9±37.7mg/dL after treatment), which also was significant (P < .001). However, a Pearson correlation test analysis revealed only a weak positive association between changes in Lp-PLA₂ and LDL-C (r²=0.052, P < .001).

Conclusion

Lp-PLA₂ is reduced with the use of life style counseling and combination lipid lowering therapy. Results also revealed that changes in Lp-PLA₂ may be partially explained by the changes in LDL-C.

Keywords: Lp-PLA₂, LDL-C, Low saturated fat diet, Low carbohydrate diet, Combination therapy, Statin, Niacin