LIPOPROTEIN (A) -- THE NEXT RISK FACTOR FOR HEART DISEASE?

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Summary and Comment

LIPOPROTEIN (A) -- THE NEXT RISK FACTOR FOR HEART DISEASE?

While several studies have suggested a positive association between lipoprotein(a) [Lp(a)] levels and the incidence of coronary heart disease, no analysis has established Lp(a) as an independent risk factor for premature CHD. This prospective study is based upon Lp(a) data for enrollees in the Framingham offspring cohort.

From 1971 to 1975, lipid levels were measured in a total of 2191 men aged 20 to 54. All subjects were free of major cardiovascular disease at baseline, but 248 (11 percent) had elevated plasma Lp(a) levels. During a median follow-up of 15 years, 129 men had a major CHD event (including 79 myocardial infarctions) by age 55. Multivariate analysis adjusting for other lipid levels and clinical data revealed a relative risk of 1.9 for elevated plasma Lp(a). Based upon its prevalence and relative risk, the authors concluded that Lp(a) was a risk factor for CHD similar in importance to a total cholesterol level of 240 mg/dl or more, or an HDL level less than 35 mg/dl.

Comment: These findings from a high-quality prospective study suggest that Lp(a) may soon make the leap from research test to clinical screening tool.

— TH Lee

Published in Journal Watch General Medicine September 10, 1996

Citation(s):

Bostom AG et al. Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger: a prospective study. JAMA 1996 Aug 21 276 544-548.