Lipoprotein-associated phospholipase A2, hormone use, and the risk of ischemic stroke in postmenopausal women

Sylvia Wassertheil-Smoller, Charles Kooperberg, Aileen P. McGinn, Robert C. Kaplan, Judith Hsia, Susan L. Hendrix, JoAnn E. Manson, Jeffrey S. Berger, Lewis H. Kuller, Matthew A. Allison, Alison E. Baird

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Abstract

Few studies have investigated the role of elevated lipoprotein-associated phospholipase A2 (Lp-PLA2) with stroke risk, and those that have are based on small numbers of strokes. No study has evaluated the effect of hormone therapy use on the association of Lp-PLA2 and stroke. We assessed the relationship between Lp-PLA2 and the risk of incident ischemic stroke in 929 stroke patients and 935 control subjects in the Hormones and Biomarkers Predicting Stroke Study, a nested case-control study from the Women's Health Initiative Observational Study. Mean (SD) levels of Lp-PLA2 were significantly higher among case subjects (309.0 [97.1]) than control subjects (296.3 [87.3]; P<0.01). Odds ratio for ischemic stroke for the highest quartile of Lp-PLA2, compared with lowest, controlling for multiple covariates, was 1.08 (95% CI: 0.75 to 1.55). However, among 1137 nonusers of hormone therapy at baseline, the corresponding odds ratio was 1.55 (95% CI: 1.05 to 2.28),whereas there was no significant association among 737 hormone users (odds ratio: 0.70; 95% CI: 0.42 to 1.17; P for interaction=0.055). Moreover, among nonhormone users, women with high C-reactive protein and high Lp-PLA2 had more than twice the risk of stroke (odds ratio: 2.26; 95% CI: 1.55 to 3.35) compared with women low levels in both biomarkers. Furthermore, different stroke cases were identified as high risk by Lp-PLA2 rather than by C-reactive protein. Lp-PLA2 was associated with incident ischemic stroke independently of C-reactive protein and traditional cardiovascular risk factors among nonusers of hormone therapy with highest risk in those who had both high C-reactive protein and high Lp-PLA2.

Original languageEnglish (US)
Pages (from-to)1115-1122
Number of pages8
JournalHypertension
Volume51
Issue number4 PART 2 SUPPL.
DOIs
StatePublished - Apr 2008

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1-Alkyl-2-acetylglycerophosphocholine Esterase
Stroke
Hormones
C-Reactive Protein
Odds Ratio
Biomarkers
Women's Health
Observational Studies
Case-Control Studies
Therapeutics

Keywords

  • Hormones
  • Lipoprotein-associated phospholipase A
  • Lp-PLA
  • Postmenopausal women
  • Stroke
  • Stroke biomarkers
  • WHI
  • Women's Health Initiative

ASJC Scopus subject areas

  • Internal Medicine

Cite this

Lipoprotein-associated phospholipase A2, hormone use, and the risk of ischemic stroke in postmenopausal women. / Wassertheil-Smoller, Sylvia; Kooperberg, Charles; McGinn, Aileen P.; Kaplan, Robert C.; Hsia, Judith; Hendrix, Susan L.; Manson, JoAnn E.; Berger, Jeffrey S.; Kuller, Lewis H.; Allison, Matthew A.; Baird, Alison E.

In: Hypertension, Vol. 51, No. 4 PART 2 SUPPL., 04.2008, p. 1115-1122.

Research output: Contribution to journalArticle

Wassertheil-Smoller, S, Kooperberg, C, McGinn, AP, Kaplan, RC, Hsia, J, Hendrix, SL, Manson, JE, Berger, JS, Kuller, LH, Allison, MA & Baird, AE 2008, 'Lipoprotein-associated phospholipase A2, hormone use, and the risk of ischemic stroke in postmenopausal women', Hypertension, vol. 51, no. 4 PART 2 SUPPL., pp. 1115-1122. https://doi.org/10.1161/HYPERTENSIONAHA.107.103721
Wassertheil-Smoller, Sylvia ; Kooperberg, Charles ; McGinn, Aileen P. ; Kaplan, Robert C. ; Hsia, Judith ; Hendrix, Susan L. ; Manson, JoAnn E. ; Berger, Jeffrey S. ; Kuller, Lewis H. ; Allison, Matthew A. ; Baird, Alison E. / Lipoprotein-associated phospholipase A2, hormone use, and the risk of ischemic stroke in postmenopausal women. In: Hypertension. 2008 ; Vol. 51, No. 4 PART 2 SUPPL. pp. 1115-1122.
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abstract = "Few studies have investigated the role of elevated lipoprotein-associated phospholipase A2 (Lp-PLA2) with stroke risk, and those that have are based on small numbers of strokes. No study has evaluated the effect of hormone therapy use on the association of Lp-PLA2 and stroke. We assessed the relationship between Lp-PLA2 and the risk of incident ischemic stroke in 929 stroke patients and 935 control subjects in the Hormones and Biomarkers Predicting Stroke Study, a nested case-control study from the Women's Health Initiative Observational Study. Mean (SD) levels of Lp-PLA2 were significantly higher among case subjects (309.0 [97.1]) than control subjects (296.3 [87.3]; P<0.01). Odds ratio for ischemic stroke for the highest quartile of Lp-PLA2, compared with lowest, controlling for multiple covariates, was 1.08 (95{\%} CI: 0.75 to 1.55). However, among 1137 nonusers of hormone therapy at baseline, the corresponding odds ratio was 1.55 (95{\%} CI: 1.05 to 2.28),whereas there was no significant association among 737 hormone users (odds ratio: 0.70; 95{\%} CI: 0.42 to 1.17; P for interaction=0.055). Moreover, among nonhormone users, women with high C-reactive protein and high Lp-PLA2 had more than twice the risk of stroke (odds ratio: 2.26; 95{\%} CI: 1.55 to 3.35) compared with women low levels in both biomarkers. Furthermore, different stroke cases were identified as high risk by Lp-PLA2 rather than by C-reactive protein. Lp-PLA2 was associated with incident ischemic stroke independently of C-reactive protein and traditional cardiovascular risk factors among nonusers of hormone therapy with highest risk in those who had both high C-reactive protein and high Lp-PLA2.",
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