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|Measurement of Lipoprotein-Associated Phospholipase A2 (Lp-PLA2) in the Assessment of Cardiovascular Risk
|Medical Policy
|Original Policy Date
|Last Review Status/Date
Reviewed with literature search/6:2013
|Return to Medical Policy Index
Our medical policies are designed for informational purposes only and are not an authorization, or an explanation of benefits, or a contract. Receipt of benefits is subject to satisfaction of all terms and conditions of the coverage. Medical technology is constantly changing, and we reserve the right to review and update our policies periodically.
Lipoprotein-associated phospholipase A2 (Lp-PLA2), also known as platelet-activating factor acetylhydrolase, is an enzyme that hydrolyzes phospholipids and is primarily associated with low-density lipoproteins (LDLs). Accumulating evidence has suggested that Lp-PLA2 is a biomarker of coronary artery disease (CAD) and may have a proinflammatory role in the progression of atherosclerosis.
Low-density lipoproteins (LDL) have been identified as the major atherogenic lipoproteins and have long been identified by the National Cholesterol Education Project (NCEP) as the primary target of cholesterol-lowering therapy. LDL particles consist of a surface coat composed of phospholipids, free cholesterol, and apolipoproteins, surrounding an inner lipid core composed of cholesterol ester and triglycerides. Traditional lipid risk factors such as low-density lipoprotein-cholesterol (LDL-C), while predictive on a population basis, are weaker markers of risk on an individual basis. Only a minority of subjects with elevated LDL and cholesterol levels will develop clinical disease, and up to 50% of cases of coronary artery disease (CAD) occur in subjects with 'normal' levels of total and LDL cholesterol. Thus, there is considerable potential to improve the accuracy of current cardiovascular risk prediction models.
Lipoprotein-associated phospholipase A2 (Lp-PLA2), also known as platelet-activating factor acetylhydrolase, is an enzyme that hydrolyzes phospholipids and is primarily associated with LDLs. Accumulating evidence has suggested that Lp-PLA2 is a biomarker of CAD and may have a proinflammatory role in the progression of atherosclerosis. The recognition that atherosclerosis represents, in part, an inflammatory process has created considerable interest in measurement of proinflammatory factors as part of cardiovascular disease risk assessment.
Regulatory Status
The U.S. Food and Drug Administration (FDA) cleared for marketing an enzyme-linked immunosorbent assay (ELISA) test, the PLAC test (diaDexus, San Francisco, CA), to measure levels of Lp-PLA2.
Measurement of lipoprotein-associated phospholipase A2 (Lp-PLA2) is considered investigational.
Policy Guidelines
Effective January 1, 2007, there will be a specific CPT code for this test:
83698: Lipoprotein-associated phospholipase A2 (Lp-PLA2).
Prior to 2007, there was no specific CPT code for this test. CPT code 83516 (immunoassay, analyte, quantitative, not otherwise specified) might have been used.
Benefit Application
BlueCard/National Account Issues
State or federal mandates (e.g., FEP) may dictate that all FDA-approved devices may not be considered investigational and thus these devices may be assessed only on the basis of their medical necessity.
This policy was created in October 2003 and updated periodically with literature review. The most recent update with literature review covers the period of April 2012 through May 15, 2013.
A large body of literature has accumulated on the utility of risk factors in the prediction of future cardiac events. The evidence reviewed for this policy statement consists of large, prospective cohort studies that have evaluated the association of lipoprotein-associated phospholipase A2 (Lp-PLA2) with cardiovascular outcomes. A smaller amount of literature is available on the utility of Lp-PLA2 as a treatment target.
The National Cholesterol Education Program (NCEP) ATP-III guidelines (1) document notes that to determine their clinical significance, the emerging risk factors should be evaluated against the following criteria in order to determine their clinical significance:
- Significant predictive power that is independent of other major risk factors
- A relatively high prevalence in the population (justifying routine measurement in risk assessment)
- Laboratory or clinical measurement must be widely available, well standardized, inexpensive, have accepted population reference values, and be relatively stable biologically.
- Preferable, but not necessarily, modification of the risk factor in clinical trials will have shown reduction in risk.
A 2002 TEC Assessment (2) summarized the steps necessary to determine utility of a novel cardiac risk factor. Three steps were required:
- Standardization of the measurement of the risk factor
- Determination of its contribution to risk assessment. As a risk factor, it is important to determine whether the novel risk factor […] independently contributes to risk assessment compared to established risk factors.
- Determination of how the novel risk assessment will be used in the management of the patient, compared to standard methods of assessing risk, and whether any subsequent changes in patient management result in an improvement in patient outcome.
Lp-PLA2 as a predictor of cardiovascular disease. Results of numerous, large-scale observational studies have examined whether lipoprotein-associated phospholipase A2 (Lp-PLA2) is an independent risk factor for coronary heart disease. A representative sample of some of the larger studies is given below.
The Emerging Risk Factors Collaboration performed a patient-level meta-analysis of the association of novel lipid risk factors with cardiovascular risk. (3) Records from 37 prospective cohort studies enrolling 165,544 participants were combined to predict cardiovascular risk over a median follow-up of 10.4 years. The authors examined the independent association of markers with cardiovascular risk and the ability to reclassify risk into clinically relevant categories. For Lp-PLA2, there were 11 studies enrolling 32,075 participants that measured this factor. Overall, Lp-PLA2 was an independent risk factor for cardiovascular events with a hazard ratio of 1.12 (95% confidence interval [CI]: 1.09-1.21) for each 1 standard deviation (SD) increase in Lp-PLA2 activity. There was no significant improvement in risk reclassification following the addition of Lp-PLA2 to the reclassification model, with a net reclassification improvement of 0.21 (-0.45 to 0.86). The net reclassification improvement crossing 0.0 indicates that the addition of Lp-PLA2 to the model may result in either improvement or worsening of reclassification.
The West of Scotland Coronary Prevention Study (WOSCOPS) was a 5-year, case control trial evaluating 6,595 men with elevated cholesterol levels and no history of a heart attack. (4) Researchers looked at a smaller population of this study to determine if inflammatory markers such as Lp-PLA2 and high-sensitivity C-reactive protein (hsCRP) were correlated with coronary heart disease (CHD) events. The 580 men who went on to have a myocardial infarction (MI) or revascularization were compared to 1,160 age- and smoking-matched men who did not have an event. The results showed that those with the highest levels of Lp-PLA2 had twice the risk of an event compared to those with the lowest levels, even after adjustment for traditional risk factors and other inflammatory mediators.
The Atherosclerosis Risk in Communities (ARIC) study (5) evaluated the various risk markers and their association with increased risk in a large, diverse population of more than 12,000 individuals. At enrollment in the study, patients were free of CHD and were followed up for the development of the disease for the next 9 years. The case-cohort component of the study examined 2 inflammatory markers, Lp-PLA2 and hsCRP, in a subset of 608 cases and 740 controls. The results showed that elevated levels of Lp-PLA2 are higher in incident coronary heart disease cases. In individuals with nonelevated low-density lipoprotein (LDL) levels (less than 130 mg/dL), Lp-PLA2 levels were independently associated with CHD, even after adjustment for traditional risk factors and C-reactive protein. Koenig and colleagues (6) reported similar results in a study of 934 apparently healthy men aged 45 to 64 who were followed up between 1984 and 1998. During this period, 97 men experienced a coronary event. Elevated levels of Lp-PLA2 appeared to be predictive of future coronary events in middle-aged men with moderately elevated total cholesterol, independent of C-reactive protein.
Ballantyne and colleagues (7) studied Lp-PLA2 in the 12,762 apparently healthy individuals participating in the ARIC study. Mean levels of both Lp-PLA2 and C-reactive protein were higher in the 194 stroke cases; the authors concluded that Lp-PLA2 levels may provide complementary information beyond traditional risk factors in identifying those at risk for ischemic stroke. As part of the PEACE study, (8) Lp-PLA2 levels were measured in 3,766 patients with stable CAD followed up for a median of 4.8 years. After adjustment for other baseline risk factors, patients in the highest quartile of Lp-PLA2 were 1.4 times more likely (95% confidence interval [CI]: 1.17–1.70, p<0.001) to experience an adverse cardiovascular outcome compared to patients in the lowest quartile. Winkler and colleagues (9) studied 3,232 consecutive patients referred for coronary angiography and reported that Lp-PLA2 levels were an independent predictor of cardiac mortality (hazard ratio: 2.0; 95% CI: 1.4–3.1, p<0.001) after adjusting for established risk factors, including C-reactive protein and N-terminal b-natriuretic peptide. Persson and colleagues (10) evaluated the relationship between Lp-PLA2 and the metabolic syndrome in 4,480 nondiabetic patients without a history of coronary artery disease (CAD). Both Lp-PLA2 (relative risk [RR]: 1.54; 95% CI: 1.07–2.24) and the metabolic syndrome (RR: 1.42; 95% CI: 1.06–1.90) were significant predictors of a first cardiac event. The combination of both elevated Lp-PLA2 and metabolic syndrome conferred a further increase in risk (RR: 1.97; 95% CI: 1.34–2.90).
The Rancho Bernardo Study (11) enrolled 1,077 community-dwelling elderly individuals without known heart disease and followed up patients a mean of 16 years for the development of heart disease. Lp-PLA2 was an independent predictor of cardiac events, with a relative risk for patients in the second, third, and fourth quartiles of 1.66, 1.80, and 1.89, respectively, compared with the first quartile.
Most, but not all, observational studies reported a positive association of Lp-PLA2 with cardiovascular outcomes. Allison and colleagues (12) studied 508 patients with peripheral vascular disease followed for an average of 6.7 years. While there was a modest univariate association of Lp-PLA2 with cardiovascular events, this association disappeared after adjustment for established risk factors. In the Rotterdam Coronary Calcification Study, (13) similar results were reported. This population-based study followed 520 patients for 7 years and evaluated the association between Lp-PLA2 and coronary calcification by electron-beam computed tomography scan. The unadjusted odds ratio (OR) for each standard deviation (SD) increase in Lp-PLA2 was 1.6 (95% CI: 1.1–2.4); however, this association became nonsignificant after controlling for lipid levels.
Some studies have specifically evaluated Lp-PLA2 as a risk factor in the diabetic population. For example, Saremi et al. (14) performed a substudy of the Veterans Affairs Diabetes trial (VADT) examining risk factors that predicted the progression of coronary artery calcification over an average of 4.6 years of follow-up. Lp-PLA2 mass was 1 of 2 significant independent predictors that remained (p=0.01) after adjustment for standard risk factors. Hatoum et al. (15) evaluated Lp-PLA2 as a risk factor for incident coronary heart disease in 1,517 diabetic patients enrolled in the Health Profession Follow-Up Study. After adjustment for standard risk factors, the RR for incident CHD for the upper quartile of Lp-PLA2 activity compared to the lower quartile was 1.39 (95% CI: 1.01-1.90, p=0.03).
Other studies have correlated Lp-PLA2 levels with different parameters of cardiovascular disease. Multiple publications have reported that Lp-PLA2 levels are associated with characteristics of "vulnerable atherosclerotic plaques," both in the coronary (16) and in the carotid arteries (17). A subsequent publication also found an association between Lp-PLA2 levels and plaque rupture. (18)
A number of systematic reviews have been published that summarize the observational studies on the association of Lp-PLA2 and cardiovascular disease. (19-21) For example, Garza and colleagues (19) reviewed 14 observational studies enrolling 20,549 patients. This study reported the predictive ability of Lp-PLA2 levels for cardiovascular disease after adjustment for traditional cardiac risk factors. The combined odds ratio (OR) for an elevated Lp-PLA2 was reported as 1.60 (95% CI: 1.36–1.89) for the development of future cardiac events. A patient-level meta-analysis (20) evaluated the association between Lp-PLA2 levels, CAD, stroke, and mortality. A total of 79,036 participants from 32 prospective studies were included in this report. There were significant associations found between Lp-PLA2 and all 3 outcome measures. For every 1 SD increase in Lp-PLA2 levels, the RR adjusted for conventional risk factors was 1.10 (95% CI: 1.04-1.17) for CAD, 1.08 (95% CI: 0.97–1.20) for stroke, and 1.16 (95% CI: 1.09-1.24) for vascular death. There was also a significant association found between Lp-PLA2 levels and non-vascular deaths (RR: 1.10, 95% CI: 1.04–1.17). The authors estimated that this strength of association was similar to that seen for non-high-density lipoprotein (HDL) cholesterol and systolic blood pressure.
Numerous additional studies were identified that evaluated Lp-PLA2 as a risk factor for cardiovascular outcomes, including some that have been published more recently than the systematic reviews discussed above. (22, 23) The majority of these evaluated Lp-PLA2 as an independent risk factor for coronary disease in various patient populations.
Another study evaluated the discriminatory ability of Lp-PLA2 for incident CHD in 421 cases and 800 controls from the Nurses' Health Study. (24) Lp-PLA2 was a significant predictor of CHD after adjustment for traditional risk factors with a RR of 1.75 (95% CI: 1.09-2.84). It also added significantly to the discriminatory ability, as judged by an increase in the area under the curve from 0.720 without Lp-PLA2 to 0.733 with Lp-PLA2, and improved the net reclassification improvement index for discriminating between patients with and without CHD (p=0.004).
Conclusions. There is a large amount of evidence establishing that Lp-PLA2 levels are an independent predictor of cardiovascular risk factors, physiologic measures of cardiac disease, and cardiovascular events. This association has been demonstrated in a variety of clinical populations, in individuals both with and without cardiovascular disease. The evidence on the ability of Lp-PLA2 to reclassify patients into clinically relevant categories is less convincing, with the largest patient-level meta-analysis reporting no significant improvement.
Lp-PLA2 as treatment target. Interventional studies involving Lp-PLA2 suggest that the level of Lp-PLA2 is modifiable by antihyperlipidemic drugs (e.g., statins, fibrates, and niacin). An ad hoc study of the PROVE IT-TIMI 22 (Pravastatin or Atorvastatin Evaluation and Infection Therapy—Thrombolysis In Myocardial Infarction) trial, (25) in which Lp-PLA2 levels were measured at baseline (n=3,648) and at 30 days (n=3,265) and patients were followed up for a mean of 24 months for death, MI, unstable angina, revascularization, or stroke, suggested that patients randomized to atorvastatin 80 mg/day, but not pravastatin 40 mg/day, experienced a 20% reduction of Lp-PLA2 levels at 30 days, independent of other cardiac risk factors. The 30-day, Lp-PLA2 level was independently associated with an increased risk of cardiovascular events. Another ad hoc study from the DIACOR (Diabetes and Combined Lipid Therapy Regimen) trial (26) demonstrated improved Lp-PLA2 levels (overall 16.8% reduction) compared to baseline, with no difference found between treatment groups among the 300 patients with diabetes and mixed dyslipidemias randomized to either fenofibrate 160 mg/day, simvastatin 20 mg/day, or both, for 12 weeks.
Rosenson randomized 55 hyperlipidemic subjects with metabolic syndrome to fenofibrate or placebo. (27) Fenofibrate treatment was associated with a 13% reduction in Lp-PLA2 mass compared to placebo. Saougos et al. studied the effect of 3 lipid-lowering agents, rosuvastatin, ezetimibe, and fenofibrate, on Lp-PLA2 levels. (28) All 3 agents significantly lowered Lp-PLA2 levels; fenofibrate also selectively increased HDL-associated Lp-PLA2 levels.
At least 2 clinical trials have examined the change in Lp-PLA2 levels in patients treated with statins versus placebo and evaluated whether the utility of Lp-PLA2 for risk stratification is modified by statin treatment. (29, 30) Ridker et al. analyzed the changes in Lp-PLA2 levels among patients in the JUPITER trial, a randomized controlled trial (RCT) of 17,802 individuals randomized to rosuvastatin or placebo. (29) Among patients assigned to rosuvastatin, Lp-PLA2 mass decreased by 33.8%. In the placebo group, Lp-PLA2 levels were predictive of subsequent cardiac events, but this was not true in the rosuvastatin group. In a similar analysis of the MIRACL RCT, Ryu et al. analyzed 2,587 patients treated with high-dose atorvastatin or placebo. (30) Atorvastatin reduced Lp-PLA2 levels in 2,587 patients treated with high-dose atorvastatin or placebo. Atorvastatin reduced Lp-PLA2 mass by 32.1% and Lp-PLA2 activity by 29.5%. In the placebo group, Lp-PLA2 levels were predictive of adverse cardiac outcomes, but no relationship was found in the atorvastatin group. The authors estimated that treatment with statins reduced the attributable risk of death due to Lp-PLA2 by approximately 50%.
Preliminary clinical trials of Lp-PLA2 inhibitors have been published, although none of the Lp-PLA2 inhibitors have been approved by the U.S. Food and Drug Administration (FDA) for any indication. Darapladib was the first drug of this class that was tested. Mohler et al. randomized 959 patients with hyperlipidemia receiving atorvastatin to placebo or 1 of 3 doses of darapladib. (31) Dose-dependent inhibition of Lp-PLA2 was noted, ranging from 43% to 66% compared with placebo. The inflammatory markers interleukin-6 and hsCRP were also reduced by 12.3% and 13%, respectively. Serruys et al. randomized 330 patients with documented CAD to darapladib or placebo and reported the impact of 12 months of treatment with darapladib on Lp-PLA2 levels, hsCRP levels, and coronary plaque composition, as measured by intravascular ultrasound. (32) This study found no difference in plaque deformability but a reduction in plaque necrotic core was reported for the darapladib group. Lp-PLA2 levels were decreased by 59%, but there were no significant differences in hsCRP levels between groups.
A second phospholipase A2 inhibitor, varespladib, is also being tested in early clinical trials. There are at least 2 Phase III studies underway on these agents. (33) The STABILITY trial is a randomized, double-blind placebo-controlled trial of darapladib for patients with chronic CAD. The trial is projected to enroll more than 15,000 patients from 800 clinical centers worldwide and report on the primary outcome of major adverse cardiovascular events. The FRANCIS-ACS trial is a randomized, double-blind, placebo-controlled trial of varespladib for patients with acute coronary syndrome. This trial is projected to enroll 700 patients, with follow-up for at least 24 weeks, and report on the primary endpoint of major cardiovascular events.
Trials of Lp-PLA2 continue to be ongoing. A third Phase III trial was identified using darapladib as treatment for CAD. (34) The Stabilization of plaques using Darapladib – Thrombolysis in Myocardial Infarction 52 (SOLID-TIMI 52) trial will enroll approximately 11,500 participants within 30 days of acute MI. Participants will be randomized to darapladib or placebo and followed for 3 years for the outcomes of cardiovascular death, nonfatal MI, or stroke. This trial is currently in the recruitment phase.
Conclusions. Levels of Lp-PLA2 decrease substantially following treatment with anti-lipid medications, including statins. However, there are not currently well-accepted thresholds for using Lp-PLA2 as a treatment target. Some studies have reported that treatment with statins eliminates the predictive ability of Lp-PLA2 as a treatment target; this may potentially reduce the potential of Lp-PLA2 for this purpose.
Inhibitors of Lp-PLA2 have been developed and tested in clinical trials, but no trials have demonstrated an improvement in health outcomes with these inhibitors. Further Phase III clinical trials are ongoing.
There is a large body of literature evaluating lipoprotein-associated phospholipase A2 (Lp-PLA2) as a predictor of cardiovascular risk. These studies demonstrate that Lp-PLA2 is an independent predictor of cardiovascular disease but do not demonstrate that health outcomes are improved as a result of measuring Lp-PLA2. Improved risk prediction does not by itself result in improved health outcomes. To improve outcomes, clinicians must have the tools to incorporate emerging risk factors into existing risk prediction models, and these models should demonstrate improved classification into risk categories that will lead to more appropriate treatment. These tools are not currently available to the practicing clinician for Lp-PLA2. As a result, use of Lp-PLA2 for risk stratification for cardiovascular disease is considered investigational.
Clinical trials of Lp-PLA2 inhibitors are a new line of research with therapeutic potential. However, the available trials are preliminary, reporting only on physiologic outcomes such as reduction in high-sensitivity C-reactive protein (hsCRP), and use a pharmacologic agent that is not yet approved for use in the U.S. At least 3 Phase III clinical trials that utilize clinical outcomes as the primary endpoint(s) are currently in progress, and results from these may be available starting in 2012. Therefore, Lp-PLA2 has not demonstrated improved outcomes as a treatment target and is considered investigational for this purpose.
Practice Guidelines and Position Statements
The American College of Cardiology Foundation (ACCF) and American Heart Association (AHA) published joint guidelines on the assessment of cardiovascular risk in asymptomatic patients in 2010. (35) The guidelines contained the following statement concerning testing for LpA-PLA2:
- Lipoprotein-associated phospholipase A2 might be reasonable for cardiovascular risk assessment in intermediate-risk asymptomatic adults. (Class IIb recommendation; Level of Evidence B)
The American Association of Clinical Endocrinologists (AACE) published guidelines for the management of dyslipidemia and prevention of atherosclerosis in 2012. (36) These guidelines made the following recommendations for LpA-PLA2 testing:
- Assess markers of inflammation in patients where further stratification of risk is necessary. Highly sensitive CRP and Lp-PLA2 provide useful information in these instances and appear to be synergistic in predicting risk of CVD and stroke. (Grade B recommendation; best level of evidence 1)
- Measure Lp-PLA2, which in some studies has demonstrated more specificity than highly sensitive CRP [hsCRP], when it is necessary to further stratify a patient's CVD risk, especially in the presence of systemic highly sensitive CRP elevations (Grade B recommendation; best level of evidence 2).
- National Cholesterol Education Program Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Adult Treatment Panel III guidelines. 2001. Available online at: http://www.nhlbi.nih.gov/guidelines/cholesterol/atp3xsum.pdf. . Last accessed May 2012.
- Blue Cross and Blue Shield Association Technology Evaluation Center (TEC). C-Reactive Protein as a Cardiac Risk Marker (Special Report). TEC Assessments 2002; Volume 17, Tab 23.
- Di Angelantonio E, Gao P, Pennelis L et al. Lipid-Related Markers and Cardiovascular Disease Prediction. JAMA 2012; 307(23):2499-506.
- Packard CJ, O'Reilly DS, Caslake MJ et al. Lipoprotein-associated phospholipase A2 as an independent predictor of coronary heart disease. West of Scotland Coronary Prevention Study Group. N Engl J Med 2000; 343(16):1148-55.
- Ballantyne CM, Hoogeveen RC, Bang H et al. Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident coronary heart disease in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Circulation 2004; 109(7):837-42.
- Koenig W, Khuseyinova N, Lowel H et al. Lipoprotein-associated phospholipase A2 adds to risk prediction of incident coronary events by C-reactive protein in apparently healthy middle-aged men from the general population: results from the 14-year follow-up of a large cohort from southern Germany. Circulation 2004; 110(14):1903-8.
- Ballantyne CM, Hoogeveen RC, Bang H et al. Lipoprotein-associated phospholipase A2, high-sensitivity C-reactive protein, and risk for incident ischemic stroke in middle-aged men and women in the Atherosclerosis Risk in Communities (ARIC) study. Arch Intern Med 2005; 165(21):2479-84.
- Sabatine MS, Morrow DA, O'Donoghue M et al. Prognostic utility of lipoprotein-associated phospholipase A2 for cardiovascular outcomes in patients with stable coronary artery disease. Arterioscler Thromb Vasc Biol 2007; 27(11):2463-9.
- Winkler K, Hoffmann MM, Winkelmann BR et al. Lipoprotein-associated phospholipase A2 predicts 5-year cardiac mortality independently of established risk factors and adds prognostic information in patients with low and medium high-sensitivity C-reactive protein (the Ludwigshafen risk and cardiovascular health study). Clin Chem 2007; 53(8):1440-7.
- Persson M, Hedblad B, Nelson JJ et al. Elevated Lp-PLA2 levels add prognostic information to the metabolic syndrome on incidence of cardiovascular events among middle-aged nondiabetic subjects. Arterioscler Thromb Vasc Biol 2007; 27(6):1411-6.
- Daniels LB, Laughlin GA, Sarno MJ et al. Lipoprotein-associated phospholipase A2 is an independent predictor of incident coronary heart disease in an apparently healthy older population: the Rancho Bernardo Study. J Am Coll Cardiol 2008; 51(9):913-9.
- Allison MA, Denenberg JO, Nelson JJ et al. The association between lipoprotein-associated phospholipase A2 and cardiovascular disease and total mortality in vascular medicine patients. J Vasc Surg 2007; 46(3):500-6.
- Kardys I, Oei HH, Hofman A et al. Lipoprotein-associated phospholipase A2 and coronary calcification. The Rotterdam Coronary Calcification Study. Atherosclerosis 2007; 191(2):377-83.
- Saremi A, Moritz TE, Anderson RJ et al. Rates and determinants of coronary and abdominal aortic artery calcium progression in the Veterans Affairs Diabetes Trial (VADT). Diabetes Care 2010; 33(12):2642-7.
- Hatoum IJ, Hu FB, Nelson JJ et al. Lipoprotein-associated phospholipase A2 activity and incident coronary heart disease among men and women with type 2 diabetes. Diabetes 2010; 59(5):1239-43.
- Liu YS, Hu XB, Li HZ et al. Association of lipoprotein-associated phospholipase A(2) with characteristics of vulnerable coronary atherosclerotic plaques. Yonsei Med J 2011; 52(6):914-22.
- Sarlon-Bartoli G, Boudes A, Buffat C et al. Circulating lipoprotein-associated phospholipase A2 in high-grade carotid stenosis: a new biomarker for predicting unstable plaque. Eur J Vasc Endovasc Surg 2012; 43(2):154-9.
- Liu CF, Qin L, Ren JY et al. Elevated plasma lipoprotein-associated phospholipase A(2) activity is associated with plaque rupture in patients with coronary artery disease. Chin Med J (Engl) 2011; 124(16):2469-73.
- Garza CA, Montori VM, McConnell JP et al. Association between lipoprotein-associated phospholipase A2 and cardiovascular disease: a systematic review. Mayo Clin Proc 2007; 82(2):159-65.
- Thompson A, Gao P, Orfei L et al. Lipoprotein-associated phospholipase A(2) and risk of coronary disease, stroke, and mortality: collaborative analysis of 32 prospective studies. Lancet 2010; 375(9725):1536-44.
- Vittos O, Toana B, Vittos A et al. Lipoprotein-associated phospholipase A2 (Lp-PLA2): a review of its role and significance as a cardiovascular biomarker. Biomarkers 2012; 17(4):289-302.
- Cook NR, Paynter NP, Manson JE et al. Clinical utility of lipoprotein-associated phospholipase A(2) for cardiovascular disease prediction in a multiethnic cohort of women. Clin Chem 2012; 58(9):1352-63.
- Lind L, Simon T, Johansson L et al. Circulating levels of secretory- and lipoprotein-associated phospholipase A2 activities: relation to atherosclerotic plaques and future all-cause mortality. Eur Heart J 2012; 33(23):2946-54.
- Hatoum IJ, Cook NR, Nelson JJ et al. Lipoprotein-associated phospholipase A2 activity improves risk discrimination of incident coronary heart disease among women. Am Heart J 2011; 161(3):516-22.
- O'Donoghue M, Morrow DA, Sabatine MS et al. Lipoprotein-associated phospholipase A2 and its association with cardiovascular outcomes in patients with acute coronary syndromes in the PROVE IT-TIMI 22 (PRavastatin Or atorVastatin Evaluation and Infection Therapy-Thrombolysis In Myocardial Infarction) trial. Circulation 2006; 113(14):1745-52.
- Muhlestein JB, May HT, Jensen JR et al. The reduction of inflammatory biomarkers by statin, fibrate, and combination therapy among diabetic patients with mixed dyslipidemia: the DIACOR (Diabetes and Combined Lipid Therapy Regimen) study. J Am Coll Cardiol 2006; 48(2):396-401.
- Rosenson RS. Fenofibrate reduces lipoprotein associated phospholipase A2 mass and oxidative lipids in hypertriglyceridemic subjects with the metabolic syndrome. Am Heart J 2008; 155(3):499 e9-16.
- Saougos VG, Tambaki AP, Kalogirou M et al. Differential effect of hypolipidemic drugs on lipoprotein-associated phospholipase A2. Arterioscler Thromb Vasc Biol 2007; 27(10):2236-43.
- Ridker PM, Macfadyen JG, Wolfert RL et al. Relationship of Lipoprotein-Associated Phospholipase A2 Mass and Activity with Incident Vascular Events among Primary Prevention Patients Allocated to Placebo or to Statin Therapy: An Analysis from the JUPITER Trial. Clin Chem 2012; 58(5):877-86.
- Ryu SK, Mallat Z, Benessiano J et al. Phospholipase A2 enzymes, high-dose atorvastatin, and prediction of ischemic events after acute coronary syndromes. Circulation 2012; 125(6):757-66.
- Mohler ER, 3rd, Ballantyne CM, Davidson MH et al. The effect of darapladib on plasma lipoprotein-associated phospholipase A2 activity and cardiovascular biomarkers in patients with stable coronary heart disease or coronary heart disease risk equivalent: the results of a multicenter, randomized, double-blind, placebo-controlled study. J Am Coll Cardiol 2008; 51(17):1632-41.
- Serruys PW, Garcia-Garcia HM, Buszman P et al. Effects of the direct lipoprotein-associated phospholipase A(2) inhibitor darapladib on human coronary atherosclerotic plaque. Circulation 2008; 118(11):1172-82.
- Suckling KE. Phospholipase A2 inhibitors in the treatment of atherosclerosis: a new approach moves forward in the clinic. Expert Opin Investig Drugs 2009; 18(10):1425-30.
- Corson MA. Darapladib: an emerging therapy for atherosclerosis. Ther Adv Cardiovasc Dis 2010; 4(4):241-8.
- Greenland P, Alpert JS, Beller GA et al. 2010 ACCF/AHA guideline for assessment of cardiovascular risk in asymptomatic adults: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2010; 56(25):e50-103.
- Jellinger PS, Smith DA, Mehta AE et al. American association of clinical endocrinologists' guidelines for management of dyslipidemia and prevention of atherosclerosis. Endocr Pract 2012; 18 Suppl 1:1-78.
|Lipoprotein-associated phospholipase A2 (Lp-PLA2)
|ICD-9-CM Diagnosis
|Investigational for all diagnoses
|ICD-10-CM (effective 10/1/14)
|Investigational for all diagnoses
|ICD-10-PCS (effective 10/1/14)
|Not applicable. No ICD procedure codes for laboratory tests.
Cardiac Risk Factor, Lp-PLA2
Lipoprotei-associated Phospholipase A2, Cardiac Risk Factor
Lp-PLA2, Cardiac Risk Factor
PLAC, Laboratory Test
Policy History
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|Policy updated with literature search; policy statement unchanged; reference numbers 5 and 6 added
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|Policy updated with literature search and new coding; no changes to policy statement. Reference numbers 7-13 added. CPT coding updated
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|Policy updated with literature search; no changes to policy statement. Reference numbers 14-19 added.
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|Policy updated with literature search; no changes to policy statement. Reference numbers 20-26 added
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|Policy updated with literature search; no changes to policy statement. Policy rationale extensively condensed and revised. Reference numbers 2, 15, and 22 added
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|Policy updated with literature search through April 2011; no changes to policy statement. References 16-18 and 26 were added.
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|Policy updated with literature search through April 2012; no changes to policy statement. References 15-17, 20, 26 and 27 were added.
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|Policy updated with literature search through May 15, 2013, references 22,23 added. No change to policy statement.


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Briefs: OA Road Trip November 21, 2008
Snowmass to celebrate its opening
Snowmass mountain in Snowmass Village opens Thanksgiving day and with it, the area has a ton of entertainment planned on and off the slopes. On Friday, Nov. 28, the Silvertree Hotel is…
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I've been getting disastrous haircuts for years and was desperately looking for someone who understood curly hair when I found Renay. Not only is she incredibly sweet and welcoming, she knew exactly how to cut my hair and always does a great job. I go in every few months and I've never been disappointed.
Even though this salon specializes in curly hair, don't count it out if you have thick straight hair. Cherish is incredibly talented with cuts and color. I'm not the best at communicating what I want, but I do know what I like and Cherish is amazing at working with me to pull out my ideas and incorporating her own professional knowledge to create a style that I fall in love with every time. She is a genius when it comes to color and an amazing personality that will instantly win you over. I wouldn't trust my hair with anyone else.
I had a lovely time with Gina at Serendipity Salon, and adore my new haircut. Gina was a welcoming and warm presence for my first visit to the salon, as well as a true professional. I've never had someone pay such close attention to detail when it comes to the shape and precision of my curls. I have incredibly thick and curly hair, with scalp issues due to hard water, years of swimming and product build-up. Gina gave me a complimentary scalp treatment since it was my first time visiting Serendipity Salon. When that didn't completely get rid of the gummy build-up, we tried exfoliating with coffee grounds and Gina also gave me some ideas for rinses and cleanses that I can do at home in between visits. Gina was very attentive throughout the process, providing me with tea and making sure I was comfortable and clear with every change she was making to my hair, from product information to styling techniques. She also "de-bulked" my hair, which has already made a world of difference in drying time and the manageability and volume of my hair. The price of my cut ($80) was higher than I'm used to paying at other salons, but I absolutely recommend spending the money for an excellent curly cut and an informative and relaxing experience!
I had long hair (3A curls) and I came in wanting a drastic change. I wanted a short cute curly bob. Cherish was wonderful! She listened to what I wanted and told me what she thought would look best. The cut is fantastic. It is exactly what we talked about and I LOVE it! I have never had my hair this short before, but I am so excited! I have had my hair cut at Serendipity several times in the past and always leave very happy. The salon is so cozy and welcoming. I highly recommend it to everyone, especially those with curly hair!
Renay is a dream, as is the rest of the Serendipity staff. I will be leaving the University of Michigan this coming May, and one of the biggest losses will be moving away from such a professional, skilled, and fun hair stylist. I remember walking in for my first cut two years ago and falling in love instantly! Renay talked through my hair type (curly, 2B), care tips, and her plan for my hair- not just what she was going to do for this cut, but what she could do in the future (growing out old layers, getting some length, etc). Going to Serendipity isn't just about getting a cut, it's about making your hair truly healthy. She has taught me so much about hair and really has gone above and beyond the call of duty to make me feel not only at home in her salon, but also to make sure I have an amazing cut every time. It has been such a treat to go to this salon and I (and my curls!) will miss it greatly. I recommend it to all of my friends, and cannot stress enough what a great experience going to Serendipity is. These girls know curls- they'll make you love them just as much as they do. Trust me, you won't get a cut like this anywhere else. Thanks so much Serendipity!!
I love getting my hair cut at Serendipity. I've been coming here for a few years now, first with Carmen and then with Renay. Today I got a cut from Renay and the washing, awesome exfoliating scalp scrub, and drying/styling by one of the girls who is new since my last visit (forgot her name unfortunately, but she was great!). Renay usually spends some time playing around with my hair first to consider what kinds of layers and length will work best. I'm trying to grow some more length now so we did a cut that is flattering at shoulder length but should continue to grow out well. She always remembers what we did last time and how my hair grows, even though I often go 6 months or more between cuts. I always recommend Serendipity to anyone who asks about a curly hair salon!
I've been to Serendipity at least a few times, with Renay cutting my hair all but once. She is very sweet, but I found the cuts inconsistent. I had a couple of really great ones, a couple that were just ok, and my last one was with Darian (even though it was supposed to be Renay) and I was not happy. She cut my hair wet and said something about cutting long layers, and I had to correct her. Not ok! I won't go back. The price was also never the same.
Without a doubt the best natural hair special salon period!! Very professional, sweet, and attentive. I big chopped my hair on December 14 , 2013 and Gina was awesome! She made the experience so pleasant and exciting...she was so supportive and happy for me-:) the owner Renay is so sweet and spoils you with refreshments and humour! Love them! If you are planning to trim your hair or big chop..Run, don't walk to Serendipity salon!!!
Gina exceeded my every expectation! Case in point: I happened to mention my recent bout with dandruff--frustating, to say the least. Without missing a beat, she began applying a scalp treatment---and for 2o minutes. 20 minutes! Where does this happen? What is more, she took time to get to know my hair, instead of jumping right into the trim and co-wash, which were the reasons for my visit. If you are looking for someone who cares about your hair the way you do, then Gina (and others there, I'm sure) is the stylist for you. I recommend her enthusiastically!
Gina exceeded my every expectation! When I happened to mention my recent bout with dandruff, she was so responsive and immediately began apply a scalp treatment, massaging oils into the hair for twenty minutes. That's 20 minutes! Mind you, I was there for a simple trim and co-wash. Gina's the kind of stylist every customer dreams of: someone who's as dedicated to your hair as you are. Thanks for a great experience, Gina. Roz
I recently went to Serendipity for the first time, it was even better than I hoped. I absolutely love how Gina cut my hair. The layers she cut in are perfect. She really listened to what I wanted and gave me some great advice. Both she and Renay were friendly and made me feel so welcome. It was truly the best salon experience! I'm looking forward to my next appointment.
I'm sixteen and have been transitioning since March 2012, my sister recommended me to go to this salon which she said she had a great experience her first time a few weeks ago. I came in for a mini big chop and when I first walked in I was welcome by Renay while Gina was finishing a client. I love the atmosphere and friendly conversations I felt at home, I never get that feeling at any salon I've ever been to in the Ann Arbor/ Ypsilanti area. Gina is a great stylist she's friendly and fun to talk to while she's doing your hair. I was first unsure about getting rid of the little bit of relaxer I had left because my hair was already short. But when she was done I loved it and couldn't wait to get home and try a Bantu-knot out on my hair. I love what Gina did to my hair and will definitely be making another appointment to see her again. This is the salon I will be going to throughout the rest of my natural hair journey.
I went to Renay last week on a friend's recommendation. Having been going to a beauty school for the past three years, I was amazed at how comfortable and welcoming the atmosphere is AND how quickly she was able to give me a beautiful cut (I had to cut out 3+ hours to go to the beauty school)! It was so amazing getting my hair done by someone who not only understands curly hair, but LOVES it! Renay spent my appointment explaining to me what she was doing, and teaching me tips and tricks for how to care for and style my hair. Renay was able to give me layers that maximize my curls and take off weight without taking off much length at all, and I love my length! I wanted to wait a few days before writing my review because I wanted to get to know my cut, and after a crazy-busy weekend my hair was still able to be worn down on the THIRD DAY after a wash! I not only have my second day hair back (which I haven't had in ages), but it can go longer! I've already made my next appointment at Serendipity :)
All in all, Darian was truly amazing. I walked in having failed at going natural quite a few times, and wanting to truly commit. Darian didn't just cut and style my hair. She helped me to understand what was going wrong and what needs to be done to get my hair to how I want it to be. I highly recommend!
I selected this salon for my 'Big Chop 2.0.' I went to another salon, twice, and they still did not cut off my relaxed ends. I chose to go to Serendipity to 'fix' my hair because of all of the positive reviews. Also, they seemed to be really dedicated to healthy hair. I found that other 'natural' salons weren't so 'natural' after all. I talked to Darian on the phone when I was booking my appointment. I really appreciated that she took the time to understand what I wanted done and talked to me about what to expect when I got there. I don't know how to describe the salon in any way other than warm and inviting. Darian greeted me at the door when I came in, which was nice. Renay is also very friendly. I had the best, most comprehensive consultation with Darian before she got started. She gave me great tips for hair care and helped me to understand my texture. I felt good about wearing my hair in its natural state for the first time. It's wonderful to go to a salon that appreciates your hair, as it is, and doesn't try to change it or make you feel like you should change it. The cut itself looks great because it fits my head/face. I've gotten so many complements. My hair is doing well, and I've been maintaining it the way Darian showed me. It was a little bit of a drive, but the salon is worth it.
I found Serendipity Salon after doing extensive research on the internet. I have never been to a salon like this before! The atmosphere is welcoming and feels very natural, like going to a relative's house to visit. Everyone is expresses genuine warmth and they are so knowledgeable about all kinds of hair – including thick, natural afros. Salons like Serendipity are few and far between. It has been many years since I have worn a short afro and I was happy to find a salon that embraces simple natural African American hair styles. I had the pleasure of having Darian "co-wash", cut and shape my hair today. Darian talked me through the whole process and gave me some awesome tips on "co-washing". I was amazed that she was able to comb through my hair with a regular comb! She was so gentle and patient with my thick hair. She approached my hair like an artist, sculpting a magnificent work of beauty. Now it is vibrant, healthy, and a breeze to maintain. I will definitely return in a couple of months for her special treatment. I highly recommend Darian to friends and family!
I had the pleasure of having Darian cut and shape my hair over the weekend. I found this salon due to the CharyJay vid on the salon and its owner Renay. I had been in desperate need of a cut/shaping for months, but didn't trust anyone to do it.This was my first cut as a natural so I was excited to find a salon that wasn't scared and knew their stuff when it came to African American hair. Darian talked me through the whole process from the layered cut she thought would work best for me (showing me how much hair she would cut) to the co wash and products used on my hair. She gave me some awesome tips on how to make co washing work for me so my curls would "pop" even more. I also appreciated how gentle she was with my hair.There was no forcing the comb through my hair causing unnecessary breakage(a big warranted fear of mine w/ salons). I loved the results when I left the salon and I love it even more a day later. My hair has so much more life and the volume is out of control! I love my big hair! LOL! I will defintely be back and will be recommending Darian to friends/family!
Serendipity is an incredible salon. I've been seeing Renay to cut (and as I'm seeing a few grays now, to color) my 3c hair for years now. Renay has an intimate knowledge of curly hair, and I always walk out happy and feeling beautiful. The salon is very charming and friendly with amazing service and always an offer of coffee and treats. Renay has seen me through boyish short cuts to the long mane I have now, and everything in between. Go and your curls with thank you!
Serendipity is a great salon. I have curly hair, I'm not very familiar with the typing system but the circumference is a bit bigger than a pencil or sharpie, so I think that's 3c ish? Anyway, I live in Lansing, MI but after stumbling upon the great reviews for this place I knew I wanted to visit for myself. . She did a phenomenal job, Id highly recommend her and even took business cards to pass out. The only thing close to a drawback is they do not have a card reader, they only take cash or checks. I don't carry checks so I offered to run to an ATM, but Renay said not to worry about it, just send a check (of my mothers) in the mail! To my fellow curlies, don't be discouraged by Renay or Darian's straight hair, they have a great appreciation for curly hair and you should definitely check them out! I'll definitely be making another trip down from Lansing as my tapered, cropped do grows out. My sister is already excited to see iggy again. Cybil was very friendly as well, but she does facials and such. And they offer you coffee or herbal tea too.
I've been in the market for a new salon for about a year. After being disappointed by other salons in the area that received high marks for curly hair, I think I've found the right place! Renay immediately put me at ease with her extensive knowledge of curly hair -- she knew my hair better than I did after playing with it for about 2 seconds! Not only did she give me an amazing cut that is easy to maintain and still looks awesome even a month later, she also took the time to give me tips for hair care -- I've tried her DIY scalp scrub several times and I swear, my hair has never looked or felt silkier. On top of being a great stylist, Renay is also a kind, interesting, and hilarious woman, and she made my experience at Serendipity absolutely perfect!
I was super nervous about getting my haircut after a bad cut at another salon in town, since my hair can be finicky about a lot of things. Renay gave me a lot of great advice of things to do or try--some of which I'll do, others of which I'm happier doing the way I've done it for ages--but great that she knows so much about curly hair and is so helpful with advice or tips and tricks. I wish I could manage to tie my hair like she did, but I'll keep practicing! Everyone was really friendly, and focused on organic products. She even had advice for my itchy scalp. When I need a cut again, I will most likely go back to keep my hair happy and healthy with Renay!
I've had several cuts from Renay and previously Carmen, and I've been extremely happy with their work every time. Renay is clearly both knowledgeable and passionate about hair. I typically just come in with a vague idea about the length I'd like, and she always comes up with a flattering cut and shape. I've also learned a number of helpful tips about caring for and styling my hair, which can range between ringlets and unpleasantly limp waves, depending on how it's treated. They are currently using Original Moxie hair products, made by a local company with high quality, natural ingredients. Renay has a charmingly quirky personality and will make you feel right at home the first time you come in. Additional perks of visiting this salon include a hot beverage and a greeting from the their small, adorable, well-behaved dog.
I had another wonderful haircut from Renay today. The salon is warm and friendly and Renay always makes me feel comfortable and welcome. Most importantly, she is a wonderful stylist and my curly hair look better than it ever has. Since I started going to Serendipity people actually have stopped me on the street to compliment my salt and pepper very curly hair. I've learned to love my hair thanks to the wonderful Serendipity cuts -- Renay is the absolute best!!
Renay is awesome and her salon is very cute. She has a beautiful spirit and you can tell she loves hair and loves making it healthy. I am African American and began my naturally curly journey 4 months ago. I never had a relaxer, but I have spent a good portion of my 35 years pressing and flat ironing my hair, so I have heat damaged hair and ends. During my transition to natural, I have struggled with those straight pieces of hair that would just never curl. I was so ready to go see Renay after reading the great reviews online. I wanted to see if she could help my hair in anyway. Well, she worked miracles! She spent time with me during my consultation understanding my hair and my hair issues. She made me feel totally comfortable and I felt that my hair was in great hands. Renay gave my hair the life it needed by shaping it and making it healthy by getting rid of all the unhealthy ends. She found curls, I never know I had. There's more work to be done to get my hair healthier and I feel so at ease knowing that I have Renay to help me during this journey. Sue her assistant is a delight as well. These are awesome girls!
I have put off having my hair cut for 2 years, but decided to take the plunge with Renay. It was well worth it! As her assistant Sue put it, she is the "Curl Whisperer". I have never had a hair cut I was so pleased with. Not only that, but Renay gave me lots of ideas for other hair styles, care of my hair, etc. I will be taking my daughter there in a few weeks - her hair has even tighter curls than mine - and I think Renay is just the person to help me figure out what to do with it. My hair has found a home at last...
Renay cut and highlighted my hair last week and I love it! I have recieved compliments every day since my cut. I have to admit I was a little worried when I saw that Renay doesn't have curly hair herself, but she knows what she's doing. I will definitely be back for another cut and I will be keeping the dark red color. Renay really knows what she is doing, she is very nice, and she never makes you feel like you are inconveniencing her like some stylists do.
Renay cut and highlighted my hair last week and I love it! I have recieved compliments every day since my cut. I have to admit I was a little worried when I saw that Renay doesn't have curly hair herself, but she knows what she's doing. I will definitely be back for another cut and I will be keeping the dark red color. Renay really knows what she is doing, she is very nice, and she never makes you feel like you are inconveniencing her like some stylists do.
OMGoodness!!!!!!! Renay is AMAZING!! I am African-American with 3c/4a curls my curls were like butta in her hands! I live in England now but waited to come back to the US just so I could have her cut my hair!!! She gave me the most relaxing head massage to give my roots some stimulation and blood circulation which not only relieved my stress but also made my curls very soft to the touch at the root. She is very knowledgeable about curl pattern, hair growth, and framing hair to your face so that you get volume in the right places and your face isn't swallowed up by your hair. She also knows a lot about natural hair care and gave me such a confidence booster by showing me different styles I could do. Not only that she has an awesome personality, someone you can chat and laugh with all day over coffee and tea...literally as they serve you coffee and tea in the salon and it's like catching up with your favorite sister! It's such a personable and calming atmosphere, not to mention her adorable small and perfect cuddly rescue dog Iggy who had a news article written about him :) If you are looking for a warm, fun, knowledgeable and AMAZING hair dresser, please call Renay today!!!! Seriously, she can cut any texture hair, it's her passion to make curlies beautiful and she's good at it!
I saw Renay today, and she gave me the most amazing cut. The layers framing my face are beautiful, she got her hands in my hair and knew just what to do to make it look its best. I couldn't be happier with the cut. Seriously, my curly hair is GORGEOUS. Renay is also the sweetest person, with a very curl-friendly, laid-back attitude. I can't wait to see her again before my brother's wedding in November. After you see Renay, you'll send all your friends there, I promise. I send mine to her.
Nervous, yep thats probably the best way to describe trying to find someone to cut my curly hair and understand what my tresses need [African American female with type 3C hair]...... Renay was the answer at Serendipity Salon in Ann Arbor, what a breath of fresh air. She totally got me and my curly locks! We scheduled an interview, discussed what I wanted and her input on what her vision was for my hair. She even trimmed my hubby's eyebrows during our interview ;) Fast forward a month and I'm happy to say..... new cut and........... I'm rocking my curls........ "totally fierce"! Thanks Renay U Rocked My World Girl ;) Totally Awesome!!! - Deborah M.
I recently moved to Michigan, which meant having to find someone new to cut my very thick, long, and very curly hair. I was a little worried about someone new cutting my hair, and the price did scare me off a little, but I decided to give it a try anyway. From the moment I walked in I got nothing but excellent service. I was offered something to drink and, once I had my steaming cup of coffee, Carmen sat down with me and we talked about my hair. She asked me several questions about how I liked to wear it and I told her about my process and what I did and didn't like to do with my hair. She's very knowledgeable and it shows in the finished product. If you're looking for a salon that's going to pile your hair with product and dry it or damage it with styling tools then this isn't the place for you. However, if you're looking for someone who is interested in the health of your hair and is more than happy to share her knowledge about how to keep your hair and scalp healthy and how to get the most out of your curls without subjecting them to chemicals or excess heat, then this is the place for you. I walked out of there with bouncy, lovely curls and hair that felt soft and smelled divine.
I had my hair cut again back in December, Carmen worked her artistry as usual with efficiency!
I got excited about this salon after reading the great reviews regarding Carmen. The salon is just ok. If you have curly hair and have no idea what to do with it, you might really like this place. But if you have curly hair that is stylish and you want it to look really beautiful, this is not the place for you. They will charge you $70. for a very basic hair cut and then just put you under the dryer. You will walk out looking like you just let your hair air dry with it not having any sort of prettiness or style to it whatsoever. I had to go work afterward and was embarrassed about the way my hair looked that day! I also told Carmen that I like my top layer shorter than what the curly hair book suggests. She replied that hairstyling was not just doing what the book says, and I liked that. But when it came to cutting my hair, she said the top layer needed to grow because I should be able to be tuck it behind my ear. So, she does go by the book afterall...and once again I had to go home and finish up a hair cut that I paid way to much for without getting what I wanted. Still searching for a curly salon that really wants to bring out the beauty in curly hair and not just dry it naturally and call it a day.
I am originally from Michigan, but currently live in Europe. I decided to go natural almost 6 months ago, and when I went back home to visit family I discovered this salon. I read all of the reviews about Carmen, and really got excited to see her and sit in her chair. I was not disappointed. She informed me about the condition and texture of my hair, and made me even more excited about the whole process. She put warm highlights in the front, and taught me a new technique for styling. I would definitely recommend her services to all curly hair ladies (and men) :-)
Having just moved to Ann Arbor, I needed to find a stylist who could deal with my mop of corkicelli curls who wouldnt destroy all of the progress I had made to keep it healthy. I came into the salon already knowing a TON about the care and maintenance of curly hair and specifically knowing what works for my hair. Even knowing what I do, Carmen was able to tell me even more, such as how to put my hair back without using an elastic hair tie, as well as how to keep my curls from flattening on the top. Carmen was very sweet and friendly, even in the midst of a pretty bad bout of morning sickness. She sat me down and we immediately began to talk curls. She listened to what I wanted, giving her own suggestions as well. Since I am in the process of growing my curls very long, she is going to give me more suggestions for styles I can do as it grows. It is a little pricey ($70) but you get what you pay for, and I am extremely happy with my cut. My ends are much healthier now, and no more frizzy ends! I highly recommend this!
Eslie is a very talented stylist. She really has a great vision and instinct for what would look good on you. She listens to you and is enthusiastic about your ideas and what you'd like. Eslie is very kind and easy-going. She is friendly and warm with a quiet, calm manner that is very relaxing and reassuring. The whole salon is very cozy, welcoming and charming. Renay is also very kind and positive. She has a great energy that is contagious. It just feels good to be there. It's a whole experience just being there and getting pampered. I love my new hairstyle! I had put off getting my hair cut and colored. I'd given up on it and just trimmed it myself and let it go gray. I was tired of the hassle. But Eslie helped me to get excited about my hair again and to have fun with it. She really listened to my concerns about the grays growing back so fast and colored my hair so beautifully with gorgeous high-lights and a warm, rich brown underneath. It is so pretty. And the blond on top with the high-lights really helps to camoflage the incoming grays so that I can get more wear out of it. I appreciate that Eslie listens and understands her clients concerns and wishes. I get compliments on my hair all the time! People say I look 10 years younger with my new hairdo. It makes me wish I hadn't put off doing it for so long. Also, I was so happy to be able to donate my long hair to Locks of Love and I got a $25.00 discount for donating it--which was very unexpected but a wonderful bonus! I definitely recommend this salon. I also had a wonderful massage and got 50% off being a new, 1st time client! It was amazing. A really fabulous experience. I will definitely be back!
Carmen is amazing! I've had experiences with some good hair stylists, but she is the best by far. She takes time to listen to what you want and then really delivers. We tried a new, darker color for a more natural look and I absolutely love it. She also does a great job cutting curly hair so that it lays just right: springy up on top and light on the bottom (I was so tired of having a Christmas tree head!!). The best thing about the salon is that they truly GET curly hair; no shampoo, no blow drying, no silicone-based products. I highly recommend Carmen and Serendipity.
Wonderful and easy and a great cut. Free Parking right at the salon (in downtown Ann Arbor, that is a plus) along with fresh coffee and a muffin. Very comfortable atmosphere at the salon, as Renay greets me with a big smile and remembers me from several years ago. So glad I found her again! She was able to take some very ratty ends and what was looking too much like a frizzy mess and transform it into a great look that I don't have to do anything with. It is completely wash and dry on the run. Tested it out the next day and yes, it is curling nicely, even in the humidity. It is still manageable, and I love the shape it gives to my face. Renay has been doing curly hair and training others to cut curly hair for years and it shows. So glad she decided not to retire!
Loved, loved, loved Carmen! She listened to what I had to say, didn't try and take over my hair. She gave me great advice and showed me how to condition and style my hair. I will definitely go back to her, as I absolutely LOVE my cut!
I am so glad I found Serendipity and Carmen! I have spent my whole life growing my curly hair out so that the weight would straighten it out, because that's what my straight-haired mom did to deal with it when I was a kid. Every stylist I ever went to before Carmen would say something like "oh, you have naturally curly hair, you poor thing," and I'd get talked into relaxing it, or just a trim. Blah! As soon as I walked in the door, Carmen knew what she wanted to do to my hair, and I love it, and it's super-cute. I am familiar with the feeling of walking out of a salon feeling good, and then having everything go back to blah a few days later, but it's been a couple of weeks now, and I'm still so happy with it. Carmen explained what she was doing, and how to keep styling my new hair on my own, and it's very easy. I know everyone has different hair, but you curly girls in Ann Arbor shouldn't be afraid to go put yourselves in Carmen's hands, you won't regret it.
Carmen instantly got very excited about my hair--it is very thick and curly. First, she introduced me to a new way of washing my hair with just conditioner and what a difference it has made! My hair is just as clean and feeling so much healthier. She listened to how I wanted it cut, gave some suggestions and the end result was great! Carmen is a very capable hairdresser and is the best curly hair cutter I have ever been to--her joy of curls makes it a pleasure to go to this stylist and salon!
I came to this salon not knowing what to expect simply because I'd never had my hair professionally done before. However, this was such a pleasant experience so I'll definitely be coming back. Eslie was super helpful and listened to what I requested, but also gave me great suggestions for my hair to look even better. She was also super nice to talk to and did a great job on my 3c hair. I definitely recommend coming here!
What a hair artist! Eslie displayed great confidence creating a lovely cascade of curls last week when I got my semiannual haircut at Serendipity. I believe this is the best haircut I have ever had and am so excited that she is at Serendipity and also appreciated the tips on conditioning! Thank you Renee too! I love your place!!! Bonus! Now there is massage offered-Caitie was the most educated massage therapist I have ever had and she actually helped my shoulder issue! Thank you so much Caitie!!
My experience at Serendipity was great. Carmen was very sweet and easy to talk to and she also thoroughly listened to what I requested for my haircut. Some stylists get scissor-happy and neglect to listen to the client's concerns but I do not think this is the case for Carmen. I have long 3c/4a hair and she gave my hair a much more attractive overall shape and yet maintained my overall length. The salon is very cute and small and has an overall very warm environment. The owner was also very kind as well. I thoroughly recommend Serendipity and Carmen for those who want a cut that both accommodates one's needs and improves upon one's own natural beauty. This salon is an Ann Arbor gem =)
Carmen has a gift for knowing exactly where to cut the hair so it cascades gently like a waterfall ...
Very personable. She gave a great cut and some very helpful information. My main issues were frizz weighed down curls, flat top, and a grown out hair cut. I'm looking forward to my next appointment. I like the fact that she kept the length of my hair, and improved the layers. Thank you Carmen!!
Carmen is the absolute best! She was the first curly hair specialist I've ever seen and I trust her completely with my hair. She listens to what you want, makes suggestions in a non-pushy way, and does an amazing job cutting your hair all while offering you drinks or chocolate! She works wonders with my 3b hair and is always ready to offer advice or just chat! She really knows her stuff! I'm going to miss her when I move away from the A2 area!
I was very excited for my haircut with Carmen after reading all of the reviews, however I was disappointed. After my cut my 3a hair was still flat and heavy on top. My previous hairstylist hand cut layers (piecing) in my hair, but Carmen only trimmed the bottom. Definitely too expensive for just a trim! My cut was $55. She listened to me but then she told me everything I was doing wrong. I already had a great grasp on working with my hair and i know what works and what doesn't. Warning: if you go to Carmen DONT ask her to straighten your hair. I usually love getting my hair blown straight at my haircut because it's a nice change that I never do myself, but Carmen is definitely opposed to changing the natural wave of your hair. But then I would ask why they dye hair at the salon?? Carmen is very knowledgeable and has some good ideas, but my hair and personality just doesn't mesh with her. Good luck!
After reading about Carmen here at naturallycurly.com, I was so, so, SO excited to see what she would be able to do with my 2c hair. After years of resisting my natural curls by straightening my hair, I was finally ready to embrace my curls and a more natural hair care routine. I made an appointment for a cut with Carmen; and let me tell you, she definitely did not disappoint!! I have had countless bad cuts over the years and only a handful of goods one, but my cut with Carmen was exceptional. She knew exactly how to cut my hair so that my curls frame the shape of my head/face perfectly. Having had so many horror hair experiences over the years, getting a haircut would sometimes be a bit stressful for me. But not with Carmen! She did everything she could to explain what she was doing, make me feel comfortable and at ease, and most importantly, she listened to what I wanted and executed it to the T. What more could a curly girl want, really? Carmen taught me a new (lower) maintenace hair care routine, and she was able to make my hair curl like it has never curled before. It was clear to me she had both the knowledge and expertise required to work with textured hair. I'm very much looking forward to going back and learning even more from Carmen and the gals at Serendipity. I would hands-down recommend Carmen to any curly girl out there! She is truly a gem!!!
Serendipity and Carmen are great! I was apprehensive about getting my hair cut (though I wasn't even going in for a real cut, more of a trim). I read about Serendipity and Carmen here on naturallycurly.com, and I decided to give it a shot. From the moment I walked in I knew it would be good. The location is great - colorful and peaceful. Right away Carmen got started asking me about my hair and what I wanted to do with it. She really listened to what I wanted, as well as offering her own ideas, but I felt no pressure to do anything. As Carmen was working on my hair, she explained everything she was doing in detail, and asking my permission, which really made me feel like we were on the same page. She really undertood my 3b/3c hair! My hair came out GREAT. I'm so happy with it! Carmen gave me her card at the end of my visit and told me to call her if anything unexpected came up, or I didn't like it the next day, or had any questions. Definitely recommend it.
I got my Big Chop done by Carmen and she did an amazing job! I called in advance because after a year of growing a substantial amount of new growth, I wanted to make sure I was putting my new curls in good hands :) She talked with me for about 10 minutes answering all of my questions over the phone (which included "Can you cut 4A, kinky, coily hair?" In to which she replied, "yes, I love that texture!") and after answering everyone with much enthusiasm and knowledge, I knew for a FACT Serendipity was where I was going to go to get my tired relaxed ends cut off! She did an amazing job and she let me film the entire experience for my YouTube channel without any problems! She was also very, very sweet! After the experience was over, she called me a week later to "check on my curls and see how they were doing!" I mean c'mon! Who could ask for better service than that????
I just had my first appointment with Carmen. I was greeted when I pulled up by the owner, Renay yelling "Welcome curly girl". I knew I was in the right place! LOL! Carmen took her time and talked with me about my hair, pros and cons, issues I have etc. She TOOK HER TIME!!! I wasn't rushed or intimidated. She explained the "no poo" way of life (which I am trying out) and gave her recommendations (without being pushy). She was very nice and LISTENED!!! She showed me a bunch of different tricks to style my hair. All together she spent an hour with me. I also had my daughter with me and she was SO sweet to her. Made her tea, played with sea shells with her. She is a cut above the rest (excuse the pun). It was hard to tell how great my cut was right away because it was beyond humid yesterday. But today after I washed and styled it (with her tips) it looks great and I am very please. It's a little shorter than I originally wanted, but the shape is so great that I really like it. THANKS CARMEN!
I just moved to Ann Arbor and needed a stylist, and based on the reviews here I went to Carmen at Serendipity this morning for a trim. She is WONDERFUL! When I walked in, she actually sat down with me to talk about my hair -- the things I like about it, don't like, and what I wanted -- before getting me washed or even settled in the cutting chair. Not only did she not bat an eye at the no-poo thing, she actually RECOMMENDED it before I even mentioned it (in fact, she said that she herself has not used shampoo on her [naturally straight!] hair for two years!). As far as the trim, I told her that I'm trying to grow my hair out for my wedding next summer, and she was very conscientious about not taking off any more length than necessary. As soon as she said, "I'm going to cut your layers to match the shape of your head," I was sold. (She added, "I want your hair to cascade down like a waterfall!") My hair looks better than it has ever looked right now. I'm going back to Carmen next week for color. So happy to FINALLY have found a stylist who loves curly hair and knows what to do with it! Carmen repeatedly told me how gorgeous my hair was and how great it is that I don't straighten it. ♥ I would highly recommend her. The trim was $55.
Serendipity Salon was exactly what I had imagined. An adorable garden bench in front of the house already makes me feel at home. The atmosphere is so warm and friendly as is Carmen and Renay. I had no fear of putting my curly locks in Carmen's expert and caring hands-I love my hair! Thank you Carmen for being you! I look forward to my next appointment truly.
Carmen was very warm and welcoming inquiring immediately about my hair and my needs. She took into account what I wanted and offered some helpful suggestions. She took time and care in cutting and styling my hair, never feeling rushed. It was a very relaxing and informative experience. I left with a great hair cut and with more knowledge on how to manage my curls.
When I walked in with my 4a hair - Carmen didn't even bat an eye - she smiled, welcomed me, and sat down with me to talk hair! i LOVED it!!!! I heard about Serendipidty/Carmen from a woman in downtown AnnArbor last year - yesterdays experience has me as a New and Repeat customer! Carmen is so gentle and more importantly KNOWLEDGEABLE about my hair type. I have received compliments about how healthy my hair looks - and, sisters are even asking ME who does my hair. Bravo Carmen!!! and Thank you!!!!!!!
The reviews are true! I'm black with 3c curls at medium length and they were not a problem for Carmen! She explained to me the growth pattern of my hair telling me things I hadn't heard before! She also cut my hair to shape my face and I have gotten several compliments on it. I'll definitely be going back!
I too went to Serendipity based on the reviews of Carmen and I agree, a great experience! I'm African American with 3c curls and they wearn't a problem for her! She also gave me some great hair tips and explained the growth pattern of my hair and showed me how she would cut it to shape my face. She did exactly what I wanted without even showing her a picture! I have gotten many compliments and will definitely be going again!
Another glowing review! I came in with frizzy, heat damaged curls hoping for a miracle. Her passion for hair was obvious and refreshing. The cut was great! The advice she gave me alone was worth the cost. My curls are better than ever! Best of all, it literally is taking me 5 minutes a day to get ready & my hair looks awesome! I highly recommend Carmen!
Carmen did a great job with my hair. My hair is super curley and gets tangeled a lot but I hate having it straight. She combed with my hair with so much care that i had no tugging or any pain (and i have a tender head). She was so careful when cutting my hair yet it seemed like she was doing it with such ease. She worked with my when styling my hair and it was almost like she took the picture of my hair that was in my brain and put it on my head. I can't wait to get my hair cut again.
Carmen is AWESOME! I saw so many good reviews of her on here so I had to check her out, she was perfect. I walked in with a picture of Kate on Lost, and I swear to god I walked out with Kate's hair. It helps that we have the same hair texture, but Carmen knew exactly what to do. I was also a little apprehensive of the "no poo" method, but my hair honestly feels AWESOME. And she didn't do anything to damage my hair, which sounds dumb, because you'd think that's the stylist's job, but she made sure to spray some no more tangles so she didn't have to yank a comb through my hair, and when she was done cutting she put me under a dryer so my hair could basically air dry. Before she cut we talked about my hair, everything I put in it, how I dry it, EVERYTHING! she was awesome. I highly recommend her.
For years I've just been going to a local place near my hometown in Minnesota, but at the end of my senior year at Michigan I was in dire need of a haircut before graduation. I decided it was time I went to my first curl specialist salon. I did some googeling, came across Carmen from her many reviews and decided to give her a try. As a new customer I was nervous, but Carmen spent almost 10 minutes chatting about my hair, my routine for styling and what I wanted before she even picked up scissors. She was extremely knowledgeable about curls, despite not having it herself. She gave me several helpful hints about hair care and my curls. She gave me a cut that was flattering and is the first hair stylist I know of who only took off the amount you asked for on overall length. The Salon itself was a very relaxed atmosphere and made me feel at home. Five stars!
I never go to the same stylist. I am always bouncing around, because I am always super nervous about letting anyone cut my hair. I read all the wonderful reviews about Carmen on NC.com, where I have looked to for information, for more than 10 years. Everything I read about Carmen was true. I explained to her that I follow the no-poo method, and was happy to hear that she follows it as well. She totally made me feel comfortable. I have super long, curly hair, and was so nervous that she would cut too much off. In the end I was left with a beautiful cut. She gave me a ton of information, and both her and Ranay were sweethearts! Thanks Serendipity! Maria
Oh, what a wonderful experience I had a Serendipity salon. Not only is the environment very warm and welcoming, but the people in it are amazing and that's what makes Serendipity so special. Carmen listened to my woes and helped me reinvent my wavy/curly hair. By giving me tips and walking me through each step she armed me with the right tools to take proper care of my hair at home and style it like a pro. Her cut put life back into my dry and stressed out hair. Thank you Carmen!! XOXO Maria
Thank you Carmen! I moved to A2 2.5 years ago, and have been to countless hairdressers. None of which I was ever satisfied. Carmen was great. She listened to what I wanted, offered some suggestions, and gave me an awesome cut. All of you curly girls who need hair help, I suggest giving Carmen a try. I could tell immediately after the cut (when hair was still dry) that she knew how to cut my curls. My hair feels lighter, and healthier.
After Carmen cut my hair, it feels so healthy and is much easier to manage! My hair is really curly and gets tangled easily, but after the cut, I had no split ends and it was really easy to comb my hair. I also liked how she took time to plan out with me exactly what I wanted. My natural hair color is a dark ash, so I've dyed it quite a bit, but the roots had been growing in and the color looked choppy. Carmen put in just the right highlights, which blended my hair to make it look really natural. Moreover, the shop is really inviting and cute and Carmen made me some wonderful coffee!
I got my hair fixed by Carmen the day before I was leaving for New York after searching around on the internet for someone who cuts curly hair. Carmen had excellent reviews and I had a good feeling about her. I'd gotten a cut the week before somewhere else that wasn't working for me. My intuition was right! Carmen was wonderful, very calming, and knew exactly what my hair needed to get it in shape. I left feeling like I'd found the person I've been looking for to cut my hair and will be definitely going back. Besides being in expert hands, Serendipity is a lovely environment; quiet and soothing. I was treated to tea and delicious organic cookies and I felt well cared for while I was there. I left happy, knowing I would have a good looking head of hair for my trip and weeks after. I got lots of compliments. If you go to this salon, you will be in good hands. I highly recommend it.
Having moved to Ann Arbor recently from Seattle, it has taken me awhile to land in the "right fit" salon. Have you ever had one of those experiences where you thought you had a particularly unique and savvy vision for how you would create something and then you encounter it? Despite having tracked professionally into a completely different arena, I have always had a still, small dream of pursuing my creativity through supporting women in expressing themselves through their appearance. Serendipity brings this vision to its superlative fruition. The environment is simultaneously artsy, professional, home-y and whimsical. Spending an afternoon at Serendipity is the equivalent of sharing some great hang-out time with your best girls plus the bonus of emerging from indulgence there looking fabulously YOU! This salon's raison d'etre is to enhance and have fun with the real you, rather than make you over or into someone else. Carmen is a genius with my mane, previously referred to at other salons as: the thickest hair they've ever seen, enough hair for three human beings and an ape, double-booked for the time it requires, double-charged for all the extra product needed, etc. One of Carmen's greatest attributes as a stylist is that she is a gifted listener. Carmen is also creative, positive and purposefully respectful of what I want. She communicates step by step before, during and after the cut/color. She is also tremendous in the same ways with my 4-yrs-old daughter and 6-yrs-old son. Carmen literally treats us as if we are her only clients when we are with her and invites both the kids and me to full expression of who we are as individuals. Her products are natural, healthy, enhancing. My wacky "Gene Wilder" (you know, the original Mr. Wonka) frizz is now a tussle of waves, ringlets and nobody-would-guess-it-color-integrated silver. I've gone from graying geekdom to groovalicious! Viva la Serendipity! --Nicole
I have never been to a salon like this before! The atmosphere is welcoming and feels very natural, like going to a relative's house to visit. Carmen immediately welcomed me when I arrived, and took the time to understand more about my hair and what I normally do with it. Then, as we went through my salon experience, she explained every aspect of what she was doing, how to clean/condition my hair, how to dry it, and how to let it's natural beauty shine through! It was like a coaching session with a haircut. The cut was very refreshing, and my hair's bounce came back. I always feel like every salon makes you feel like you need to conform to the latest hair trends, whether it fits your genes or not. Why would you want to go to anywhere else, when there is a salon out there that wants to show how you naturally look beautiful? Thanks Carmen, and also thank you, Renay!
I've been getting my hair cut by Carmen at Serendipity here for a year now, I wish I had discovered her sooner! I had a really bad haircut that I was trying to grow out. Carmen gave me a GREAT cut that worked with my naturally curly hair, and I've been going to her ever since. Hair stylists are always trying to straighten my hair, but not Carmen. She is fantastic. Her haircuts grow out really well, I mean they don't lose their shape fast. Not only is she very skilled but she is so friendly and nice. Love it!
I was back in town for a few days (I recently moved to Chicago) and made sure to get an appointment with Renay. She got me to ditch the hair dryer a while ago, and go naturally wavey rather than straighten it. I have such a great fresh new city look, and no one in Chicago can tell I'm originally from suburbia. :-) This last visit, she gave me a wonderful cut as always, and freshened my color. I usually get some version of red, and she always does a great job, but this last time she hit it out of the park! It was such a vibrant red and the color lasted, and lasted. It was beyond my expectations. I think the tip about eliminating shampoo in the morning, and just using conditioner, helps keep the red from fading.
I recently went to Serendipity for a cut. I found that the salon was very relaxing and both Megan and Renay were super nice, and made me feel welcome. Megan really seemed to know her stuff about curls, and she even mentioned the "Curly Girl" hairbook, and told me to try "not" washing my hair. However, I didn't really care for the way she cut my hair. There are shorter pieces here and there in my hair, and I do not like the way she layered it. I also found that my haircut was too overpriced. I paid $65 for a cut that really was just a trim. I really liked the salon, but not the cut.


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The Crimson Tide has completed the task four out of six times this season. Texas A&M averaged a shade over five yards with its numbers skewed a little by quarterback Johnny Manziel's running ability, while Virginia Tech averaged 4.6 yards a carry, which was aided by a 78-yard touchdown run.
But this week may be the Tide's toughest test when Arkansas travels to Tuscaloosa for a 6 p.m. showdown on Saturday in Bryant-Denny Stadium.
The Razorbacks are averaging 5.5 yards a carry and the bulk of it comes from their running backs.
"Even games they've lost, they're still averaging 150, almost 200 yards rushing," Tide linebacker C.J. Mosley said. "Their big linemen are able to control the line of scrimmage, get a good push to get up to the second level with linebackers and DBs. As long as we control the line of scrimmage, we'll have a good chance of stopping the run."
Last season, Mosley wouldn't have played a lot against a team like the one Arkansas is fielding this season. Nico Johnson stepped in against power running teams like LSU, while Mosley specialized in pass coverage against spread teams like Texas A&M.
Now, Mosley is an every-down linebacker, although even a year ago, he spent as much as 80 percent of each game on the field. That's how often Alabama was in a pass-defense package, rather than its base defense.
"It's going to be a new experience," Mosley said. "But not really too much because we go against our offense pretty much every day. So we go against some of the best linemen and one of the best offenses in the country and in the SEC. We've just got to be physical in this type of game. No excuses there."
The Razorbacks' top two rushers rank in the top six in the SEC. True freshman Alex Collins is second in the league with 720 yards and gains 5.9 yards a carry, while Jonathan Williams averages 6.5 yards a carry with 564 yards on the season.
Arkansas uses a lot of zone blocking schemes, and Alabama coach Nick Saban said "it's all about execution" when discussing how to defend the Hogs' rushing attack.
"It's about executing what you have to do, and you cannot do it unless you are physical, strike blockers and everyone stays in their gaps whatever the call is," Saban said. "I don't think there's any scheme you can draw up that you're all of the sudden going to stunt some place and they're not going to be able to block you because you can stunt yourself right out of the play as well."
Added Mosley, "For linebackers, it's all about the center. If you see the wide receivers going out for passes, but the center's coming past the line of scrimmage, you know it's a draw because they wouldn't be able to throw the ball if it wasn't. It's all about reading keys."


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Social Sciences
Social science is the field of study concerned with society and human behaviors. "Social science" is also commonly used as an umbrella term to refer to a plurality of fields outside of the natural sciences which may include: anthropology, archaeology, criminology, economics, history, linguistics, communication studies, political science and international relations, sociology, geography, law, and psychology.
Social Science classes at North Idaho College cover a broad spectrum of subject areas that include student leadership, cultural anthroplogy and ecology, resident assitant training and career development.
Social Science faculty at NIC - click on name below to see faculty information and their class/ office schedule:
Laurie Ingebritsen
Rocky Watson


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2009 February 14
BCBGMAXAZRIA - New York Fall 2009
View Gallery
(NEW YORK) "I kept clapping in front row. I loved and wanted just about everything," raved country singer Kellie Pickler. Which is good sign for Max Azria, considering the Fall BCBGMAXAZRIA collection was atypical. Functional and artistic sensibilities of Constructivism were the main focus of a show that seemed targeted for a slightly older consumer than in previous seasons. There were standout party dresses unconventionally paired with gold tights, successful micro jersey pieces, and confusing velvet numbers. Strong separates, pretty clutches and platforms were almost lost in the overstyled show, but some looks will find their place onto store shelves.


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Tom Basden Won't Say Anything
Show type: Edinburgh Fringe 2007
2007 if.comedy best newcomer
Tom Basden, one quarter of the acclaimed sketch show Cowards (Radio 4, BBC3) presents his debut full-length solo show at this years Edinburgh Festival Fringe.
This wonderfully eclectic show is an hour of deadpan musical whimsy, interspersed with words, pictures and even some tiny films.
With songs covering such wildly varying subjects as ghosts, Chris Tarrant, glass eyes, suicide, ventriloquism, hypochondria, Iraq and love and 60 second documentaries about swimming the channel and ducks, an art exhibition, and coffee and tea making facilities included, this show promises to be utterly original.
Nominated for a 2008 Chortle award for best show
Original Review:
Last year, Australian comic Claire Hooper stage an lovely, inventive but criminally overlooked show called Oh! in which she used every performance trick in the book, and some more besides, to ensure she didnt utter a word during the entire hour.
Tom Basdens title might promise something remarkably similar, but his ambition is more modest. Songs comprise almost all the show and he does sing them, but just chooses to leave the banter between each of them to his PowerPoint slides.
Most of these simply do the admin: announcing the next tune, flashing up Thank you when hes finished to acknowledge the applause that hasnt yet started. Then theres his random lists of quirky Top Five favourites things in obscure fields, such as types of water (No 2: Holy).
Hes drawn some cartoons, too, the best of which are the funniest things in the show imaginative, offbeat and with such strong ideas behind them that you chuckle long after theyve left the screen. The Far Side is probably the closest equivalent and theyre that good, too. Another visual device is to show the Google Image search results for phrases he thinks will produce suitably idiotic photographs. And they do.
Its the strength of the songs, though, that will make or break the show. Performed either with a folksy guitar or more portentous keyboard, they are mostly silly ideas set to serious music. Basden one quarter of the Cowards sketch group is basically Tim Minchin on a lower power setting.
Titles such as Im Aware That Im A Werewolf or I Used To Be Friends With Jack Bauer give an idea of the feel of the hour, ridiculous situations described as if theyre everyday conversations. Longer tracks are mixed with quickies to vary the pace and as if that wasnt enough, sometimes the colour of the screen with the captions changes colour, too. Wow!
Basden is clearly a witty, inventive man, and the gimmick is not so much that hes not talking but that hes a damn fine songwriter; another frontline warrior in the fight to overturn the cheesy image of the musical comedian.
Reviewed by: Steve Bennett
Older Comments
Harry - 26/08/2007
Award. Deserved.


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STILLWATER -- Route 4 and 32, also known as River Road, will be closed for several hours Sunday due to railroad bridge repairs.
Pan Am Railways will be working on the B&M Bridge that crosses the road and Hudson River from 6 a.m. until 6 p.m. Sunday.
Motorists will be detoured onto routes 67 and 50 and Rensselaer County Route 125, also known as Stillwater Bridge Road.
All properties in the vicinity will remain accessible to residents and emergency responders.
The state Department of Transportation would like to remind motorists that all fines are doubled for speeding in a work zone.
For travel information, call 511 or go to www.511ny.org
-- By Caitlin Morris


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No sleeves means if you've got the biceps, they'll be seen! Although there is also the modest option of wearing it like a vest over another shirt. 3 color choices here, all cool... maybe you need more than one!
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