Prognostic value of lipoprotein-associated phospholipase A2 mass for all-cause mortality and vascular events within one year after acute ischemic stroke

Background and aims We performed a prospective investigation of the longer-term prognostic value of lipoprotein-associated phospholipase A2 (Lp-PLA2) mass for all-cause mortality and vascular events within one year after acute ischemic stroke. Methods We examined the Lp-PLA2 mass among 3401 participants enrolled in the China Antihypertensive Trial in Acute Ischemic Stroke. The primary outcome was all-cause mortality. Cox proportional hazard ratios (HRs) and 95% confidence intervals (95% CIs) were constructed to assess the independent associations between the baseline Lp-PLA2 mass and the outcomes after adjustment for variables in models 1, 2, and 3 [further adjusted for low-density lipoprotein cholesterol (LDL-C)]. Results Overall, 3278 patients completed the follow-up, during which, 188 all-cause death events occurred. The Kaplan-Meier survival curve showed that the cumulative incidence rate of all-cause mortality increased across quartiles of Lp-PLA2 mass (log-rank p = 0.018). Compared with the lowest quartile of Lp-PLA2, the HRs (95% CIs) for the highest quartile of Lp-PLA2 were 1.89 (1.22–2.91), 2.16 (1.31–3.55), and 2.17 (1.32–3.58) for all-cause mortality after adjusting for the covariables in models 1, 2, and 3, respectively. In addition, patients in the highest quartile of Lp-PLA2 mass coupled with higher LDL-C had significantly highest risk of all-cause mortality (HR, 1.81; 95% CI, 1.05 to 3.11; p = 0.032). Conclusions The elevated Lp-PLA2 mass was associated with all cause-death independently of other risk factors within one year after acute ischemic stroke.