CARDIOVASCULAR JOURNAL OF AFRICA • Volume 34, No 5, November/December 2023 AFRICA 273 Association between the serum lipoprotein-associated phospholipase A2 level and acute coronary syndrome Le Dong, Jiayi Tong, Shimin Fan Abstract Aim: The aim of this study was to explore the association between serum lipoprotein-associated phospholipase A2 (Lp-PLA2) level and acute coronary syndrome (ACS), and to analyse the correlations of Lp-PLA2 concentration with highsensitivity C-reactive protein (hs-CRP) level, body mass index (BMI), triglyceride (TG), troponin I (TNI), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HDL-C) levels, and severity of coronary artery disease. Methods: A total of 75 patients were divided into an unstable angina (UA) group (n = 54) and an acute myocardial infarction (AMI) group (n = 21). Another 72 subjects with normal coronary angiography results were selected as a control group. The levels of hs-CRP, TG, LDL-C, HDL-C and TNI were determined. Serum Lp-PLA2 concentration was measured by enhanced immunoturbidimetry. The Gensini score was obtained based on coronary angiography results. Results: The serum Lp-PLA2 concentration significantly increased in the AMI and UA groups compared with that of the control group (p < 0.05). Compared with the UA group, the AMI group had significantly increased levels of hs-CRP and TNI and higher Gensini score (p < 0.05). The UA group had increased levels of hs-CRP and higher Gensini score compared with those of the control group (p < 0.05), while the two groups had similar TNI levels (p > 0.05). Using serum Lp-PLA2 concentration as the dependent variable, and hs-CRP, TG, LDL-C, HDL-C, TNI and Gensini score as independent variables, the analysis results showed that Lp-PLA2 concentration was positively correlated with BMI and hs-CRP, LDL-C and TNI levels. Conclusions: There was a positive correlation between Lp-PLA2 concentration and LDL-C level, therefore plasma LDL-C level should be controlled to prevent ACS. Keywords: acute coronary syndrome, lipoprotein-associated phospholipase A2, biochemical index, angiography Submitted 9/9/22, accepted 28/10/22 Published online 11/1/23 Cardiovasc J Afr 2023; 34: 273–277 www.cvja.co.za DOI: 10.5830/CVJA-2022-056 Acute coronary syndrome (ACS) is a clinical type of coronary heart disease, and its pathophysiological basis is as follows. Due to coronary atherosclerosis and vascular plaque instability, plaque rupture and erosion occur under a series of triggers, thus causing coronary thrombosis and incomplete or complete occlusion of the corresponding blood vessels, and ultimately, resulting in acute myocardial ischaemia and hypoxia. Whether ACS occurs is primarily dependent on the plaque stability, and has no direct relationship with the plaque size.1 With the deepening of research, there has been considerable evidence that the aggregation of inflammatory cells and the release of inflammatorymarkers are the main culprits throughout the development process of atherosclerotic plaque. At present, it is well accepted that coronary atherosclerosis is a kind of chronic vascular inflammation,2 and the hypothesis that ‘inflammation causes cardiovascular events’ has become a research hotspot. The associations of some inflammatory factors, such as highsensitivity C-reactive protein (hs-CRP), CRP, interleukin-37 (IL37) and IL-38, with the onset and prognosis of coronary heart disease have been revealed.3 Lipoprotein-associated phospholipase A2 (Lp-PLA2), a newly discovered inflammatory marker, plays an important role in the occurrence and development of atherosclerosis and the rupture of unstable plaques. The rupture of unstable plaques is crucial to the occurrence of ACS. Lp-PLA2, as an inflammatory marker, can serve as a predictor for the risk of coronary heart disease events, and its elevation indicates a high risk for coronary heart disease.4,5 However, the associations of serum Lp-PLA2 concentration with hs-CRP level, body mass index (BMI), triglyceride (TG), troponin I (TNI), low-density lipoprotein cholesterol (LDL-C) and high-density lipoprotein cholesterol (HLD-C) levels, and the severity of coronary artery disease have seldom been reported. In this article, the Lp-PLA2 concentration was compared between normal subjects and ACS patients to explore whether Lp-PLA2 could predict the occurrence of ACS. Moreover, the association between Lp-PLA2 and other clinical indicators was analysed, thereby contributing to early prevention and treatment of ACS. Methods A total of 75 patients were enrolled and divided into an unstable angina (UA) group (n = 54) and an acute myocardial infarction (AMI) group (n = 21). Another 72 subjects with normal coronary angiography results were selected as a control group. This study was approved by the ethics committee of our hospital, and written informed consent was obtained from all patients. The Lp-PLA2 kit and scattering turbidimetric analyser were purchased fromNanjing Norman Biological Technology Co, Ltd (China). Other apparatus included separation gel coagulationpromoting tubes, electric thermostatic oscillating water tank and ultra-high-speed centrifuge (Thermo Fisher Scientific, USA). Venous blood (5 ml) was drawn from each patient in the AMI group immediately after admission, and fasting venous Department of Cardiovascular Medicine, Jiangbei Campus, Zhongda Hospital affiliated to Southeast University, Nanjing, Jiangsu Province, China Le Dong, MM, donglejczh@zcxecl.com Jiayi Tong, MD Shimin Fan, MM
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