Relationship between Lp-PLA2 and the Severity of Coronary Stenosis and Prognosis in Patients with Coronary Heart Disease

LYU Dongchen; HUANG Xiao; YANG Qian; YUAN Yu

doi:10.12102/j.issn.1672-1349.2025.03.014

Abstract：Objective: To investigate the relationship between lipoprotein-associated phospholipase A2 (Lp-PLA2) and the severity of coronary artery stenosis and prognosis in patients with coronary heart disease. Methods: A total of 266 patients who underwent coronary angiography and Lp-PLA2 testing at the Department of Cardiology of the First Affiliated Hospital of Xinxiang Medical University from November 2020 to March 2022 were selected. According to the results of coronary angiography, the patients were divided into a coronary heart disease group (coronary artery stenosis ≥50%, 199 cases) and a control group (coronary artery stenosis <50%, 67 cases). According to the number of diseased vessels, the coronary heart disease group was further divided into single-vessel disease group (48 cases), double-vessel disease group (50 cases), and triple-vessel disease group (101 cases). Based on Lp-PLA2 levels, the coronary heart disease group was divided into an Lp-PLA2 elevated group (Lp-PLA2 ≥200 ng/mL, 80 cases) and an Lp-PLA2 normal group (Lp-PLA2 <200 ng/mL, 119 cases), and the two groups were stratified by gender. General data of the coronary heart disease group and the control group were compared, and Gensini scores and Lp-PLA2 levels of patients with different numbers of lesions were compared. Follow-up was conducted for patients with coronary heart disease, and the occurrence of adverse events was recorded. Multivariate COX regression risk models were used to analyze the relationship between Lp-PLA2 levels and prognosis. Kaplan-Meier method was used to draw survival curves and perform Log-rank tests. Results: Compared with the control group, the Lp-PLA2 level in the coronary heart disease group was significantly higher (P < 0.05). Compared with the single-vessel disease group and the double-vessel disease group, the Lp-PLA2 level and Gensini score in the triple-vessel disease group were significantly higher (P < 0.05). Spearman correlation analysis showed that the Lp-PLA2 level in patients with coronary heart disease was positively correlated with the degree of coronary artery stenosis (r = 0.423, P < 0.001). The incidence of adverse events in patients with elevated Lp-PLA2 was 33.8%, while that in patients with normal Lp-PLA2 was 20.2%. Multivariate COX regression analysis showed that elevated Lp-PLA2 levels were associated with increased risk of adverse events in patients with coronary heart disease [HR = 2.730, 95% CI (1.501, 4.966), P = 0.001]. Kaplan-Meier survival analysis showed that the incidence of adverse events during follow-up was higher in the Lp-PLA2 elevated group than in the Lp-PLA2 normal group (P < 0.05). After gender stratification, only male patients in the Lp-PLA2 elevated group had a higher incidence of adverse events during follow-up than those in the Lp-PLA2 normal group (P < 0.05), while there was no statistically significant difference in the incidence of adverse events between the two groups among female patients (P > 0.05). Conclusion: The Lp-PLA2 level in patients with coronary heart disease is significantly higher than that in non-coronary heart disease patients, and it is positively correlated with the severity of coronary artery stenosis, which can be used to assess the severity of coronary artery lesions. High Lp-PLA2 levels may be an independent risk factor for poor prognosis in patients with coronary heart disease, especially in male patients.