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Lp-PLA2 (lipoprotein-bound phospholipase A2)

Lp-PLA2 is an enzyme associated with low-density lipoproteins (LDL), which plays a dual role:

Functions:

  1. Pro-inflammatory activity:
  • It breaks down oxidized phospholipids into LDL, releasing lysophosphatidylcholine and oxidized fatty acids. :
    • Attract macrophages to the walls of blood vessels.
    • Contribute to the formation of atherosclerotic plaques.
  1. Risk biomarker:
  • A high level of Lp-PLA2 indicates instability of plaques and the risk of their rupture (heart attack, stroke).

Where is it produced?

  • Mainly in macrophages and lymphocytesassociated with atherosclerotic lesions.

Symptoms and consequences of Lp-PLA2 imbalance

In excess (high risk of vascular events)

  • Atherosclerosis:
  • Progression of plaques in the coronary and carotid arteries.
  • Risk of acute coronary syndromes (infarction).
  • Stroke:
  • Association with inflammation in the cerebral vessels.
  • Absence of external symptoms before the catastrophe develops (analysis is the only way to identify the risk).

In case of shortage (extremely rare)

  • It is not clinically relevant, as Lp-PLA2 is not a vital enzyme.

Lp-PLA2 standards in analyses

The level is measured in the blood (serum or plasma) by two methods:

  1. Enzyme activity (nmol / min / ml):
  • The norm: < 150 nmol / min / ml.
  • High risk: > 200 nmol / min / ml.
  1. Mass concentration (ng / ml):
  • Low risk: < 200 ng / ml.
  • Moderate risk: 200-235 ng / ml.
  • High risk: > 235 ng / ml.

When is the test scheduled?

  • Assessment of the risk of cardiovascular diseases (especially in patients with intermediate risk on the SCORE scale).
  • Control of atherosclerosis, diabetes, hypertension.
  • Monitoring the effectiveness of statins (reduce Lp-PLA2).

What should I do with elevated Lp-PLA2?

  1. LDL Reduction:
  • Statins (atorvastatin, rosuvastatin).
  • Ezetimibe (cholesterol absorption inhibitor).
  1. Anti-inflammatory therapy:
  • Dapagliflozin (an SGLT2 inhibitor) reduces Lp-PLA2 in diabetics.
  1. Changing your lifestyle:
  • Mediterranean diet (olive oil, omega-3).
  • Smoking cessation (increases LDL oxidation).

Interesting facts

  • Lp-PLA2 is independent of C-reactive protein (CRP), making it an independent marker of vascular inflammation.
  • The test is especially useful for patients with normal cholesterol, but a high risk of heart attack.

Conclusion

Lp-PLA2 is an enzyme that increases inflammation in atherosclerotic plaques.
🔹 Rules:

  • By activity: < 150 nmol / min / ml.
  • By weight: < 200 ng / ml** (low risk). 🔹 **Increase (>235 ng / ml) – a signal for aggressive prevention of heart attack/stroke.
    Correction: statins, LDL control, anti-inflammatory diet.