Lipoprotein-Associated Phospholipase A2 and Risk of Congestive Heart Failure in Older Adults The Cardiovascular Health Study

Background—Inflammation may be a causative factor in congestive heart failure (CHF). Lipoprotein-associated phospholipase A2 (Lp-PLA2) is an inflammation marker associated with vascular risk. One previous study showed an association of Lp-PLA2 activity with CHF risk, but there were only 94 CHF cases and Lp-PLA2 antigen, which is available clinically in the United States, was not measured. Methods and Results—We measured baseline Lp-PLA2 antigen and activity in 3991 men and women without baseline CHF or cardiovascular disease who were participating in the Cardiovascular Health Study, a prospective observational study of adults 65 years or older. Cox proportional hazards models adjusted for age, sex, clinic site, race, low-density and high-density lipoprotein cholesterol, body mass index, systolic and diastolic blood pressure, hypertension, smoking status, pack-years, and diabetes were used to calculate hazard ratios and 95 % CIs for incident CHF. Further models adjusted for coronary disease events during follow-up and C-reactive protein. Eight hundred twenty-nine participants developed CHF during 12.1 years. Adjusted hazard ratios for CHF with Lp-PLA2 in the fourth compared with the first quartile were 1.44 (95 % CI, 1.16 to 1.79) for Lp-PLA2 antigen and 1.06 (95 % CI, 0.84 to 1.32) for activity. Adjustment for incident coronary disease attenuated the hazard ratio for Lp-PLA2 antigen to 1.26 (95 % CI, 1.02 to 1.57), adjustment for C-reactive protein had minimal impact. Conclusions—Lp-PLA2 antigen was associated with risk of future CHF in older people, independent of CHF and coronar