Association between type II secretory phospholipase A2 plasma concentrations and activity and cardiovascular events in patients with coronary heart disease

AIMS: Type II secretory phospholipase A(2) (sPLA(2)-IIA) is widely expressed in various cell types and may trigger local inflammatory responses. We sought to evaluate whether systemic sPLA(2) is associated with prognosis in patients with coronary heart disease (CHD). METHODS AND RESULTS: Plasma concentrations of sPLA(2) (ELISA) and sPLA(2) activity (selective fluorometric assay) were measured at baseline in a cohort of 1024 patients aged 30-70 years with CHD. The Cox-proportional hazards model was used to determine the prognostic value of sPLA(2) on a combined cardiovascular disease (CVD) endpoint after adjustment for covariates. During a mean follow-up of 4.1 years, 93 patients (9.1%) experienced a secondary CVD event. In a multivariable model, sPLA(2) mass and activity were associated with hazard ratios of secondary CVD events of 2.07 (95% CI, 1.17-3.66) and 1.65 (95% CI 0.96-2.84) for mass and activity, respectively, when extreme tertiles were compared. Further adjustment for cystatin C, N-terminal-probrain natriuretic peptide, C-reactive protein, and lipoprotein-associated phospholipase A(2) attenuated the associations, still showing a positive trend for mass but a less clear pattern for activity. However, when sPLA(2) mass and activity were analysed as continuous variables both still showed a statistically significant increase in risk in all models. CONCLUSION: Secretory phospholipase A(2) mass and activity appear to be predictive of secondary CVD events in patients with CHD.