Test Details
Oxidized Phospholipids on apoB (OxPL-apoB)
Oxidized phospholipids are found on all apoB-containing lipoproteins, namely, LDL, VLDL, and especially Lp(a). When taken up by the artery wall, oxidized lipoproteins accelerate atherosclerosis, thereby, increasing the risk of myocardial infarctions, strokes, and calcific aortic valve stenosis. Oxidized phospholipids are highly pro-inflammatory and contribute to many diseases of aging. Clinicians can use OxPL-apoB levels to reclassify patients into higher or lower risk categories allowing better personalized care.
Methodology
Chemiluminescent immunoassay.
Patient Preparation
None.
Preferred Specimen
Serum collected in a serum separator tube (SST/Tiger top).
Alternate Specimen
None.
Transport Temperature
Refrigerated (ship on frozen cold packs)
Stability
Refrigerated: 6 days
Lab Values
Oxidized Phospholipids on apoB (OxPL-apoB)
- Optimal: <2.0 nM/L
- Borderline: 2.0-3.0 nM/L
- Increased Risk: >3.0 nM/L
Clinical Significance
Oxidized Phospholipids on apoB (OxPL-apoB)
Two- to three-fold increased CVD risk is seen in individuals with an OxPL-apoB value > 7.5 nmol/L as compared to those with values below this threshold.1-4
References
1. Tsimikas S et al. Oxidation-specific biomarkers, lipoprotein(a), and risk of fatal and nonfatal coronary events. J Am Coll Cardiol. 2010; 56:946-955.
2. Tsimikas S at al. Oxidation-specific biomarkers, prospective 15-year cardiovascular and stroke outcomes, and net reclassification of cardiovascular events. J Am Coll Cardiol. 2012; 60:2218-2229.
3. Byun YS et al. Relationship of oxidized phospholipids on apolipoprotein B-100 to cardiovascular outcomes in patients treated with intensive versus moderate atorvastatin therapy: The TNT Trial. J Am Coll Cardiol. 2015; 65:1286-1295.
4. Kamstrup PR et al. Oxidized phospholipids and risk of calcific aortic valve disease: The Copenhagen General Population Study. Arterioscler Thromb Vasc Biol. 2017; 37:1570-1578.
Treatment Options
Oxidized Phospholipids on apoB (OxPL-apoB)
Patients with high OxPL-apoB levels should be treated more aggressively with all preventative therapies, including optimal lipid management, blood pressure and diabetes control, and, if needed, smoking cessation and weight control.1-4 Specific OxPL-apoB-lowering therapies tested to date include niacin (20-30%), antisense oligonucleotides to Lp(a) (up to 90%), apheresis (70%), and significant weight loss (50%).1,5,6 The effect of statins on OxPL-apoB levels is variable. Higher OxPL-apoB levels tend to accompany a statin-induced increase in Lp(a), the preferential carrier of OxPL.1,7
References
1. Calvin Yeang, Ming-Yow Hung, Young-Sup Byun, Paul Clopton, Xiaohong Yang Joseph L. Witztum, Sotirios Tsimikas, Yeang C et al. Effect of therapeutic interventions on oxidized phospholipids on apolipoprotein B100 and lipoprotein(a). J Clin Lipidol. 2016; 10:594-603.
2. Vardi M, et al. Vitamin E in the prevention of cardiovascular disease: the importance of proper patient selection. J Lipid Res. 2013; 54:2307-2314.
3. Shiffman D, et al. Coronary heart disease risk, aspirin use, and apolipoprotein(a) 4399Met allele in the Atherosclerosis Risk in Communities (ARIC) study. Thromb Haemost. 2009; 102:179-180.
4. Chasman DI, et al. Polymorphism in the apolipoprotein(a) gene, plasma lipoprotein (a), cardiovascular disease, and low-dose aspirin therapy. Atherosclerosis. 2009; 203:371-376.
5. Tsimikas S et al. Lipoprotein(a) reduction in persons with cardiovascular disease. N Engl J Med. 2020; 382:244-255.
6. Arai K et al. Acute impact of apheresis on oxidized phospholipids in patients with familial hypercholesterolemia J. Lipid Res. 2012; 53:1670-1678.
7. Ky B et al. The influence of pravastatin and atorvastatin on markers of oxidative stress in hypercholesterolemic humans. J Am Coll Cardiol. 2008; 51:1653-1662.
