Sex-Specific Association Between Lp-PLA2 and Arterial Stiffness: A Cross-sectional Study

Abstract Background Lipoprotein-associated phospholipase A 2 (Lp-PLA 2 ) is a vascular-specific inflammatory enzyme implicated in atherosclerosis. However, its relationship with arterial stiffness and subclinical disease across sexes remains unclear in aging populations. Objective To investigate the sex-specific association between Lp-PLA 2 , brachial-ankle pulse wave velocity (baPWV), and cardiovascular risk factors in middle-aged and older adults. Methods We analyzed 1,031 adults aged ≥ 45 years (607 men and 424 women) from a community-based health screening cohort. Lp-PLA 2 levels were compared across sex-specific tertiles. Correlations between baPWV and cardiometabolic risk factors were examined using linear regression. Results Men had higher Lp-PLA₂ levels than women (615.25 ± 156.61 vs. 559.24 ± 127.50 IU/L, p < 0.001); moreover, a significant correlation between baPWV and Lp-PLA₂ ( p = 0.007) was only observed in women. Fasting glucose (β = −0.110, p = 0.027) and baPWV (β = 0.226, p < 0.001) were independent predictors of Lp-PLA 2 levels in women. In receiver operating characteristics analysis, an Lp-PLA₂ cut-off of 550.5 IU/L predicted subclinical atherosclerosis in women with 73.6% sensitivity. No significant correlations were found in men. Conclusion Lp-PLA 2 is independently associated with arterial stiffness in aging women but not in men. Combined assessment of Lp-PLA 2 and baPWV may enhance early detection of subclinical atherosclerosis in women and support sex-specific risk stratification strategies in cardiovascular disease prevention.