Lp - PLA2

Potential Prevention Strategies for Elevated Inflammatory Markers
Although researchers have established a positive correlation between elevated hs-CRP and cardiovascular disease, obesity, metabolic syndrome, and type 2 diabetes, researchers are still faced with determining empirically whether reducing hs-CRP will assist in reducing the relative risk of these diseases. Because it has not yet been determined whether hs-CRP is a risk factor showing a causal link between hs-CRP and the diseases, it is unknown whether targeting this inflammatory marker will reduce the relative risk. Unlike hs-CPR, there is much less research to date to indicate whether Lp-PLA2 can be prevented through specific strategies. Some research has shown Lp-PLA2 might be lowered using pharmacological agents , however more studies need to be completed before any determination can be made regarding prevention and treatment strategies for Lp-PLA2. Therefore, the strategies below will speak directly to prevention strategies for hs-CRP levels only.

hs-CRP and Pharmacological Agents

There has been some preliminary research that pharmacological agents influence hs-CRP levels, however these studies were inconclusive (Albert, Danielson, et al., 2001; Ridker, Rifai, Pfeffer, et al., 1999; Ridker, 2001). It has also been suggested that statin drugs have the most influence. It appears all subjects achieved reductions in LDL levels, however not all participants in the studies responded with lower hs-CRP levels. The clinical application of these results is unknown, however more studies are planned to determine the implication of responders versus non-responders. What researchers do know is that survival rates are poorest in subjects with high hs-CRP levels and low LDL levels compared to those with low hs-CRP-low LDL, low hs-CRP-high LDL, and high hs-CRP-High LDL (Ridker, Rifai, Rose, et al., 2002). These results suggest that lowering the hs-CRP levels may be just as beneficial as concentrating on lowering the LDL levels alone.

hs-CRP and Physical Activity

Researchers have studied the relationships of elevated hs-CRP and various forms of physical activity and exercise (Abramson & Vaccarino, 2002; Church, Barlow, et al., 2002; Ford, 2002; Isasi, Deckelbaum, et al., 2003; Keller & Lemberg, 2003; King, Carek, et al., 2003; Manns, Williams, et al., 2003; Rothenbacher, Hoffmeister, et al., 2003). It appears that active persons have a greater likelihood of having lower hs-CRP levels (Abramson & Vaccarino, 2002). Additionally, researchers have found that increasing their cardiorespiratory fitness was related to lowering hs-CRP levels, thus confirming that physical activity is associated with lower hs-CRP levels (Church, Barlow, et al., 2002). Researchers also found these positive correlations in post menopausal women (Manns, Williams, et al., 2003) as well as in children and adolescents (Isasi, Deckelbaum, et al., 2003).

The beneficial effects of exercise are well documented, however the mechanism of how physical activity prevents cardiovascular disease has not (King, Carek, Mainous, & Pearson, 2003). Physical activity has beneficial effects on cardiovascular disease risk factors, but these effects cannot be totally accounted for by reducing risk factors. The role of inflammatory markers is thought to account for the unexplained effects of exercise, however more research needs to be conducted in this area.

In addition, it has not yet been determined if specific types of activities are more beneficial in lowering hs-CRP. The bulk of the literature indicates that some forms of physical activities are more closely associated with a lower likelihood of elevated hs-CRP. However, it appears that the differences may be due to the intensity and duration, rather than the specific type of activity (King, Carek, Mainous, & Pearson, 2003). Ford (2002) found that subjects that participated in more vigorous physical activity were more likely to have lower hs-CRP levels. Manns, Williams, Snow, & Wander (2003) also found that the higher the physical activity level, the lower the hs-CRP.

The types of activity that were looked at included traditional forms of endurance training, as well as more anaerobic activities, such as weight training and interval training. It is not known whether it is the type of activity, the duration of the activity, the intensity of the activity, or a combination of all the above, that influences hs-CRP levels. Additionally, it is not known whether the lowering effects of physical activity on hs-CRP levels is a direct response or an indirect response to improvements on the vascular system. Because of these uncertainties, future research needs to be conducted to explore the effects of different types of activity on hs-CRP.

Conclusion
Research has shown that increasing physical activity helps reduce the risk of obesity, cardiovascular disease, as well as type 2 diabetes. The question remains, does lowering inflammatory markers, such as hs-CRP and Lp-PLA2 reduce the relative risk of these diseases, or is the response simply due to the physical activity itself. While there is little information regarding the course of action with respect to Lp-PLA2, it is believed that physical activity might lower the risk of hs-CRP by mitigating the inflammation, which plays a role in these diseases (Ford, 2002). The research is still inconclusive, but evidence is mounting toward the benefits of physical activity in the reduction of relative risk of these diseases by reducing the inflammation associated with these diseases.

The question is, can hs-CRP and Lp-PLA2 be empirical markers associated with reduction of cardiovascular disease risk? Also, is the protective effect of physical activity due to a differential inflammatory response to different types of activity? If so, this will lead to important implications for prevention and treatment. More studies need to be conducted before these questions can be answered definitively. In the meanwhile, healthcare professionals should continue to prescribe physical activity as an important treatment modality, because increasing physical activity is strongly correlated with lowering the relative risk of these diseases regardless of the physiological mechanisms or whether there is a causal link to lowering of hs-CRP or Lp-PLA2.

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