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, Jo Ann E. Manson, Jeffrey S. Berger, Lewis H. Kuller, Matthew A. Allison, Alison E. Baird

Research output: Contribution to journalArticlepeer-review

53 Scopus citations


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
Issue number4 PART 2 SUPPL.
StatePublished - Apr 2008


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

ASJC Scopus subject areas

  • Internal Medicine


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