Lp-PLA2 appears to act synergistically with CRP (measured as hsCRP), such that risk is substantial when both are elevated. However, while CRP is a marker of general inflammation, Lp-PLA2 appears to specifically indicate vascular inflammation and is not influenced by obesity
The American Association of Clinical Endocrinologists (AACE) and the American College of Endocrinology (ACE) announced earlier this year, the publication of clinical practice guidelines for dyslipidemia management and atherosclerosis prevention, in which a new cardiovascular risk category is introduced along with far-reaching lipid management goals (ASCVD).
Under the section “Which screening tests are recommended for the detection of cardiovascular risk”, well-known tests such as Lipid Profile, LDL-C, HDL-C, Triglycerides and Non-HDL-C as well as Apo B and/or Apo B / Apo A ratio were listed. Additional tests were also recommended hsCRP, Lp-PLA2, CAC and CIMT (other tests including homocysteine, uric acid, plasminogen activator inhibitor-1, or other inflammatory markers were not recommended because of lack of evidence).
The guidelines recommended:
Measure lipoprotein-associated phospholipase A2 (Lp-PLA2), which in some studies has demonstrated more specificity than hsCRP, when it is necessary to further stratify an individual’s ASCVD risk, especially in the presence of hsCRP elevations (Grade A; BEL 1).
Further, the guidelines stated: 'Lp-PLA2 has been identified as a strong and independent predictor of ASCVD events and CVA in individuals with and without manifest ASCVD. CRP is a marker of general inflammation, Lp-PLA2 appears to specifically indicate vascular inflammation and is not influenced by obesity. Measurement of Lp-PLA2, which appears to be more specific than hsCRP, may be helpful when it is necessary to further stratify an individual’s risk for ASCVD, especially in the presence of systemic CRP elevations.'