RELATIONSHIPS BETWEEN THE LEVELS OF LIPOPROTEINQASSOCIATED PHOSPHOLIPASE A2 AND THE RISK OF CARDIOVASCULAR EVENTS, EVALUATION OF EFFICACY OF PREVENTIVE THERAPY WITH STATINS

Aim. The purpose of the study was to elucidate the relationships between the levels of lipoprotein associated phospholipase A2 (LP  PLA2), and the risk of cardiovascular events and to evaluate the  efficacy of preventive therapy with statins. The study comprised a  total of 60 patients with coronary artery disease (CAD) associated  with type 2 diabetes mellitus who underwent endovascular  revascularization. The twelve month follow up study documented the  following events: death, myocardial infarction (MI), acute  cerebrovascular event, repeated coronary revascularization, and  recurrence of angina. Patients were assigned to two groups based on  the absence or the presence of end points: group 1 comprised  patients with unfavorable course of disease (n=30); group 2  comprised patients with favorable course (n=30). In all patients, the  study determined parameters of LP PLA2, glycemic profile, glycated hemoglobin, insulin, ApoB, Apo A1, Lp (a), and lipid profile. Homeostasis model assessment (HOMA) of insulin resistance  was determined. All patients received atorvastatin at a dose of 20– 40 mg/day. The 12 month follow up study showed that, in the  presence of atorvastatin therapy at a dose of 30 mg/day in group 1,  the levels of total cholesterol (TC), triglycerides (TG), and low density lipoprotein (LDL) cholesterol decreased by 20.71%,  26.21%, and 25.84%, respectively. In group 2, TC decreased by  30.52%, LDL cholesterol decreased by 31.41%, and ApoB decreased by 45.2%. The LP PLA2 levels decreased by 21.28% and 26.63% in  group 1 and in group 2, respectively (р=0.004). In group 1, one  patient died (3.3%). Angina reoccurred in 96.7% of subjects. Based  on coronary angiography data, 16.7% of patients had stent  restenosis; 63.3% of patients had progression of atherosclerosis.  Myocardial infarction and acute cerebrovascular event reoccurred in  10% and 3.3% of patients, respectively. Repeated revascularization  was performed in 70% of patients. LP PLA2 level may be considered a prognostic marker of unfavorable cardiovascular events in patients with CAD associated with type 2  diabetes mellitus allowing for selection of special patient cohort for more aggressive lipid correction therapy aimed at achieving  target level of LDL cholesterol.

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