Pregnancy-associated plasma protein A: Has this biomarker crossed the boundary from research to clinical practice?

Abstract

There is already a substantial body of evidence suggesting that pregnancy-associated plasma protein A (PAPP-A) participates in the atherosclerotic process. In several studies, PAPP-A has been associated with the development of vascular injury. PAPP-A has been proposed as a marker of the presence and extent of atherosclerotic disease and high-risk vulnerable plaques. It has been suggested that PAPP-A could have a role in the risk stratification of subjects in different clinical settings. Controversy exists, however, regarding the ability of commercially available assays to measure total versus free PAPP-A. The determination of PAPP-A, particularly in the very early phases of an acute myocardial infarction, may have a complementary role to that of cardiac troponins. This article focuses on the role of PAPP-A as both a marker of risk and a pathogenic factor in atherosclerotic disease.