Association between serum secretory phospholipase A2 and risk of ischemic stroke

Jed W. Smith, Raphae Barlas, Mamas A Mamas, S Matthijs Boekholdt, Ziad Mallat , Robert N. Luben, Nicholas J. Wareham, Kay-Tee Khaw, Phyo Kyaw Myint* (Corresponding Author)

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

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Background and Purpose: Previous literature has demonstrated an association between high serum levels of type-II secretory phospholipase A2 (sPLA2) concentration and an increased risk of coronary artery disease. However, such association has not been established in terms of ischemic stroke risk. We aimed to evaluate the association between both sPLA2 concentration and activity as continuous variables with risk of future ischemic stroke. Methods: We conducted a nested case-control study using data from the European Prospective Investigation into Cancer - Norfolk study. Cases (n=145) in the current study
were participants who developed ischemic stroke during follow-up, with controls (n=290) matched in a 2:1 ratio based on age and sex. Statistical analyses were performed using SPSS (version 25.0, Chicago, Ill) software. Logistic regression was used to determine odds ratios (OR) and corresponding 95% confidence intervals (95% CIs) for ischemic stroke. Results: After adjusting for a wide array of cardiovascular confounders, sPLA2 activity was found to be associated with an increased risk of ischemic stroke using both multiple imputations with chained equations and complete case analysis: OR 1.20 (95% CI: 1.01-1.43) and OR 1.23 (95% CI: 1.01 -1.49), respectively. However, sPLA2 concentration was not found to be associated with increased risk of ischemic stroke.
Conclusions: The activity of sPLA2, but not sPLA2 concentration, is associated with an increased risk of future ischemic stroke. This finding may be significant in risk group stratification, allowing targeted prophylactic treatment, or the development of novel therapeutic agents.
Original languageEnglish
Pages (from-to)3650-3655
Number of pages7
JournalEuropean Journal of Neurology
Issue number11
Early online date30 Jul 2021
Publication statusPublished - 30 Nov 2021

Bibliographical note

Acknowledgements and Funding
The EPIC-Norfolk study (DOI 10.22025/2019.10.105.00004) has received funding from the Medical Research Council (MR/N003284/1 and MC-UU_12015/1) and Cancer Research UK (C864/A14136). We are grateful to all the participants who have been part of the project and to the many members of the study teams at the University of Cambridge who have enabled this research.


  • Ischemic stroke
  • prediction
  • secretory phospholipase A2 (sPLA2)


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