Lipoprotein-Associated Phospholipase A₂ In Coronary Heart Disease:Review And Meta-Analysis

Background:Higher lipoprotein-associated phospholipase A₂?Lp-PLA₂?is closely related to coronary atherosclerotic heart disease?CHD?.There are many evidences suggesting that Lp-PLA₂ can predict atherosclerotic disease.It is related to arterial plaque characteristics and reflects the vulnerability of plaque.At the same time,Lp-PLA₂ predicts the specificity of vasculitis,and it is rarely affected by other inflammatory markers.Lp-PLA₂ also provide a new method for clinical screening of higher risk patients with atherosclerosis.This article systematically evaluates and analyzes the relationship between Lp-PLA₂ and the prognosis of patients with coronary heart disease.Methods:The author searched the literature about Lp-PLA₂ and coronary atherosclerotic heart disease in PubMed,Embase,Cochrane Library,CNKI,Wanfang,and Vip database according to the standard search strategy.RavMan5.3 provided by Cochrane was used for Meta Analysis.First,deleted duplicate article;second,eliminated the literature in the form of reviews,conference papers,editorials,and reviews;third,read the title and abstract of the article.In addition to manually searched for 4 uncollected documents.After reading 33articles,strictly abiding by the inclusion and exclusion criteria,14 articles were eventually chosen to be analysised.The Newcastle-Ottawa Scale?NOS?risk bias assessment tool was used to assess the quality of the included studies.Multivariate-adjusted hazard ratios?HRs?with 95%confidence intervals?CIs?for the risk of adverse outcomes according to Lp-PLA₂ activity or mass were extracted,pooled,and weighted using generic inverse-variance and random-effect modeling.The logHR and its standard error?SE?were calculated the by Excel.The above two sets of data were input into RevMan5.3 software.The heterogeneity test and effect model selection of the literature data,the meta-analysis statistical results and the chart were calculated.The results of meta-analysis were discussed in combination with Lp-PLA2detection method and coronary heart disease type,and the conclusions were drawn.Results:Finally,3 case-control trials and 11 cohort studies were included.Higher Lp-PLA₂ activity or mass was independently associated with an increased risk of long-term cardiovascular events,with pooled HR for cardiovascular events of HR=1.57 95%CI=1.19-2.07,P=0.002 and HR=1.4095%CI=1.10-1.79,P=0.007respectively.HigherLp-PLA₂activitywas significantly related to increased risk of long-term cardiac death than Lp-PLA₂mass?HR=1.46,95%CI=1.23-1.74,P<0.001;HR=1.34,95%CI=0.55-3.24,P=0.52?.Higher Lp-PLA₂ activity was significantly related to increased risk of long-term all-cause mortality.However,the sensitivity analysis shows poor stability and the conclusion is not reliable.Conclusions:1.Higher Lp-PLA₂ Mass may predict recurrent cardiovascular events in patients with coronary heart disease,but there is significant publication bias in the study,and further improvement of data is needed.There is no correlation with cardiac death in patients with coronary heart disease;and only one article public the relationship of higher Lp-PLA₂ and all-cause mortality in patients with coronary heart disease,ending not evaluated.2.Higher Lp-PLA₂ Activity may predict all-cause mortality.This conclusion is poorly reliable and requires more clinical evidence.It may predict recurrent cardiovascular events,as the same time there is significant publication bias in the included studies,which needs further improvement data.It can predict cardiac death in patients with coronary heart disease.