The objective of the Veterans Affairs HDL Intervention Trial (VA-HIT) was to investigate the effect of gemfibrozil on cardiovascular (CV) events in men with low HDL cholesterol and low LDL cholesterol levels. In this report, VA-HIT investigators examined whether increased lipoprotein-associated phospholipase A2 (Lp-PLA2) would predict the risk of CV events in trial participants. For each 1-standard deviation (SD) increase, baseline and on-trial Lp-PLA2 levels were associated with CV events [HR=1.17 (95% CI, 1.04-1.32) and HR=1.18 (95% CI, 1.05-1.33), respectively, for baseline and on-trial Lp-PLA2 levels]. Gemfibrozil had the greatest impact on reduced CV events in men in the top Lp-PLA2 quartile at baseline (-9.0% vs. -3.4%, respectively, for Lp-PLA2 quartile 4 and 1, p=0.03 for linear trend). Survival analyses suggested that individuals with both high LDL cholesterol levels and Lp-PLA2 levels had the highest cumulative incidence of CV events. On the whole, these results emphasize that Lp-PLA2 levels are related to the effects of gemfibrozil on CVD events in patients with low HDL cholesterol levels and coronary heart disease.
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