Lipoprotein Associated Phospholipase A2 (LP-PLA2)

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Enzyme linked to vascular inflammation.

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Lipoprotein Associated Phospholipase A2 (LP-PLA2) Test Guide

Why is it done?
- Measure enzyme activity associated with lipoprotein(a) [Lp(a)] to assess cardiovascular inflammation and risk
- Identify patients at increased risk for atherosclerotic cardiovascular disease (ASCVD) and stroke
- Stratify cardiovascular risk in patients with intermediate or borderline risk profiles
- Predict risk of recurrent cardiovascular events in patients with prior myocardial infarction or stroke
- Evaluate the role of inflammation in plaque instability and rupture
- Typically ordered during initial cardiovascular risk assessment or when additional risk stratification is needed
Normal Range
- Reference Values: ≤160 nmol/min/L (or ≤160 μmol/min/L) is generally considered the upper limit of normal
- Result Categories:
- • Low-risk range: <160 nmol/min/L • Intermediate-risk range: 160-190 nmol/min/L • High-risk range: >190 nmol/min/L
- Units: nanomoles per minute per liter (nmol/min/L) or micromoles per minute per liter (μmol/min/L)
- Interpretation:
- • Normal (Low): Result within established reference range indicates lower risk of cardiovascular events • Elevated: Higher values indicate increased inflammatory activity and greater cardiovascular risk • Results are typically interpreted in conjunction with other cardiovascular risk factors
Interpretation
- Normal Values (<160 nmol/min/L): Suggests lower inflammatory burden and reduced risk of atherosclerotic cardiovascular events; may provide reassurance in intermediate-risk patients
- Intermediate Values (160-190 nmol/min/L): Indicates borderline inflammatory activity; patient may benefit from aggressive preventive measures and closer monitoring
- Elevated Values (>190 nmol/min/L): Indicates significant inflammatory activity and increased risk; suggests need for intensive risk reduction strategies including medication consideration
- Clinical Significance:
- • LP-PLA2 is an independent predictor of cardiovascular and cerebrovascular events • Elevated levels correlate with plaque inflammation and increased risk of plaque rupture • Provides incremental information beyond traditional lipid markers (LDL, HDL, triglycerides) • Enzyme activity reflects inflammation-driven atherosclerosis progression
- Factors Affecting Results:
- • Genetic variations in enzyme production • Lipoprotein(a) [Lp(a)] levels (genetic influence) • Systemic inflammation status • Atherosclerotic disease burden • Current medications (some anti-inflammatory agents may lower levels) • Metabolic conditions affecting lipid metabolism
Associated Organs
- Primary Organ Systems:
- • Cardiovascular system (heart and blood vessels) • Cerebrovascular system (brain blood vessels) • Peripheral vasculature
- Associated Medical Conditions:
- • Coronary artery disease (CAD) • Myocardial infarction (MI) - acute and recurrent • Ischemic stroke • Peripheral arterial disease (PAD) • Atherosclerotic plaque instability • Arterial inflammation • Acute coronary syndrome (ACS)
- Complications Associated with Abnormal Results:
- • Increased risk of sudden cardiac death • Increased risk of myocardial infarction • Increased risk of stroke or transient ischemic attack (TIA) • Plaque rupture leading to acute thrombosis • Restenosis after coronary intervention • Progressive atherosclerotic disease • Heart failure from extensive myocardial damage
- Mechanism of Disease: LP-PLA2 enzyme degrades phosphatidylcholine in oxidized lipoproteins, generating pro-inflammatory mediators that promote monocyte recruitment and vascular inflammation, leading to atherosclerotic plaque destabilization
Follow-up Tests
- Recommended Complementary Tests:
- • Lipid panel (total cholesterol, LDL, HDL, triglycerides) • Lipoprotein(a) [Lp(a)] level • High-sensitivity C-reactive protein (hsCRP) • Apolipoprotein B (ApoB) • Homocysteine level • Blood pressure monitoring
- Imaging Studies to Consider:
- • Coronary artery calcium (CAC) scoring • Carotid intima-media thickness (cIMT) ultrasound • Coronary CT angiography (CCTA) • Stress testing (exercise or pharmacologic) • Cardiac CT or cardiac MRI • Carotid ultrasound for plaque assessment
- Based on LP-PLA2 Results:
- • If elevated: Consider additional imaging and more aggressive risk factor modification • If normal in intermediate-risk patient: May reduce need for intensive intervention • If recurrent events despite treatment: Evaluate for need to intensify therapy or assess medication adherence
- Monitoring Schedule:
- • LP-PLA2 is relatively stable over time; repeat testing typically not needed frequently • May repeat after 1-2 years if baseline was borderline to reassess trends • Regular monitoring of traditional risk factors (lipids, blood pressure) remains essential • More frequent follow-up recommended for patients on preventive medications
- Related Tests: Inflammatory markers (fibrinogen, interleukins), oxidized phospholipids, plaque imaging biomarkers
Fasting Required?
- Fasting Status: NO - Fasting is NOT required for LP-PLA2 testing
- Sample Collection: Standard venipuncture with collection of blood sample in appropriate tube; can be collected during routine office visit
- Patient Preparation:
- • No special dietary restrictions • No fasting period required • Patient may eat and drink normally before test • No specific medication adjustments necessary • Avoid excessive physical activity immediately before blood draw if possible
- Medications: Continue regular medications as prescribed; no need to hold or adjust medication timing before LP-PLA2 testing
- Special Instructions:
- • Inform phlebotomist of any bleeding disorders or anticoagulant use • Stay hydrated before blood draw • Sit or lie down for a few minutes after venipuncture if prone to syncope • Can coordinate with other blood tests if needed (lipid panel, etc.) • No post-draw restrictions; normal activities can resume immediately
- Sample Stability: Sample should be processed and refrigerated according to laboratory protocol; typically stable for transport to reference laboratory

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