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Lipids, Lipoproteins, and Cardiovascular Risk Factors |
1 Department of Laboratory Medicine, Children’s Hospital and Harvard Medical School, Boston, MA. 2 Channing Laboratory and 3 Center for Cardiovascular Disease Prevention, Divisions of Preventive Medicine and Cardiology, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA. Departments of 4 Nutrition and 5 Epidemiology, Harvard School of Public Health, Boston, MA. 6 Division of Metabolism, Endocrinology and Nutrition, Department of Medicine, University of Washington, Seattle, WA.
aAddress correspondence to this author at: Department of Laboratory Medicine, Children’s Hospital, 300 Longwood Ave., Boston MA 02115. Fax 617-713-4347; e-mail nader.rifai{at}tch.harvard.edu.
Background: The relationship of lipoprotein (a) [Lp(a)] concentrations with risk of coronary heart disease needs clarification, especially for threshold values for increased risk and for possible interactions with LDL-cholesterol concentrations and apolipoprotein (a) [apo(a)] size polymorphism. This study was designed to examine the ability of baseline Lp(a) concentration and apo(a) size to predict future severe angina pectoris in apparently healthy men.
Methods: Baseline Lp(a) concentration and apo(a) size were determined in 195 men who subsequently developed angina and in 195 men who remained free of cardiovascular disease for 5 years.
Results: Cases had higher median Lp(a) concentrations than did controls (30.6 vs 22.5 nmol/L; P = 0.02). Lp(a) concentration was predictive of angina [relative risk (RR) from lowest to highest quintiles: 1.0, 1.5, 1.0, 1.8, and 2.6; P for trend = 0.015]. The increased risk was 
4-fold (95% confidence interval, 1.4- to 11-fold) among men who had Lp(a) above the 95th percentile (>158 nmol/L). Men with Lp(a) concentrations in the highest quintile and LDL-cholesterol concentrations >1600 mg/L had a 12-fold increased risk (95% confidence interval, 1.5- to 43-fold). Small apo(a) size isoforms also significantly predicted risk of angina (RR for lowest quintile = 4.1; P for trend = 0.004). When the independent effect of Lp(a) concentration and apo(a) size was assessed by including them in the same multivariate model, only the association between apo(a) size and risk remained significant.
Conclusions: High Lp(a) predicts risk of angina, and the risk is substantially increased with high concomitant LDL-cholesterol. Small apo(a) size predicts angina with greater strength and independence than Lp(a) concentration.
The following articles in journals at HighWire Press have cited this article:
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  The Emerging Risk Factors Collaboration Lipoprotein(a) Concentration and the Risk of Coronary Heart Disease, Stroke, and Nonvascular Mortality JAMA, July 22, 2009; 302(4): 412 - 423. [Abstract] [Full Text] [PDF]
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P. R. Kamstrup, A. Tybjaerg-Hansen, R. Steffensen, and B. G. Nordestgaard Genetically Elevated Lipoprotein(a) and Increased Risk of Myocardial Infarction JAMA, June 10, 2009; 301(22): 2331 - 2339. [Abstract] [Full Text] [PDF]
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 P. R. Kamstrup, A. Tybjaerg-Hansen, R. Steffensen, and B. G. Nordestgaard Pentanucleotide Repeat Polymorphism, Lipoprotein(a) Levels, and Risk of Ischemic Heart Disease J. Clin. Endocrinol. Metab., October 1, 2008; 93(10): 3769 - 3776. [Abstract] [Full Text] [PDF]
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 K.-L. Chien, H.-C. Hsu, T.-C. Su, F.-C. Sung, M.-F. Chen, and Y.-T. Lee Lipoprotein(a) and Cardiovascular Disease in Ethnic Chinese: The Chin-Shan Community Cardiovascular Cohort Study Clin. Chem., February 1, 2008; 54(2): 285 - 291. [Abstract] [Full Text] [PDF]
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 P. R. Kamstrup, M. Benn, A. Tybjaerg-Hansen, and B. G. Nordestgaard Extreme Lipoprotein(a) Levels and Risk of Myocardial Infarction in the General Population: The Copenhagen City Heart Study Circulation, January 15, 2008; 117(2): 176 - 184. [Abstract] [Full Text] [PDF]
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B. Dieplinger, A. Lingenhel, N. Baumgartner, W. Poelz, H. Dieplinger, M. Haltmayer, F. Kronenberg, and T. Mueller Increased Serum Lipoprotein(a) Concentrations and Low Molecular Weight Phenotypes of Apolipoprotein(a) Are Associated with Symptomatic Peripheral Arterial Disease Clin. Chem., July 1, 2007; 53(7): 1298 - 1305. [Abstract] [Full Text] [PDF]
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J. Suk Danik, N. Rifai, J. E. Buring, and P. M Ridker Lipoprotein(a), measured with an assay independent of apolipoprotein(a) isoform size, and risk of future cardiovascular events among initially healthy women. JAMA, September 20, 2006; 296(11): 1363 - 1370. [Abstract] [Full Text] [PDF]
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L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Circulation, June 20, 2006; 113(24): e873 - e923. [Abstract] [Full Text] [PDF]
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 L. B. Goldstein, R. Adams, M. J. Alberts, L. J. Appel, L. M. Brass, C. D. Bushnell, A. Culebras, T. J. DeGraba, P. B. Gorelick, J. R. Guyton, et al. Primary Prevention of Ischemic Stroke: A Guideline From the American Heart Association/American Stroke Association Stroke Council: Cosponsored by the Atherosclerotic Peripheral Vascular Disease Interdisciplinary Working Group; Cardiovascular Nursing Council; Clinical Cardiology Council; Nutrition, Physical Activity, and Metabolism Council; and the Quality of Care and Outcomes Research Interdisciplinary Working Group: The American Academy of Neurology affirms the value of this guideline. Stroke, June 1, 2006; 37(6): 1583 - 1633. [Abstract] [Full Text] [PDF]
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 M. Can, S. Acikgoz, G. Mungan, T. Bayraktaroglu, E. Kocak, B. Guven, and S. Demirtas Serum cardiovascular risk factors in obstructive sleep apnea. Chest, February 1, 2006; 129(2): 233 - 237. [Abstract] [Full Text] [PDF]
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T. Pischon, C. J. Girman, F. M. Sacks, N. Rifai, M. J. Stampfer, and E. B. Rimm Non-High-Density Lipoprotein Cholesterol and Apolipoprotein B in the Prediction of Coronary Heart Disease in Men Circulation, November 29, 2005; 112(22): 3375 - 3383. [Abstract] [Full Text] [PDF]
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 C. Hernandez, G. Francisco, P. Chacon, and R. Simo Lipoprotein(a) as a Risk Factor for Cardiovascular Mortality in Type 2 Diabetic Patients: A 10-year follow-up study Diabetes Care, April 1, 2005; 28(4): 931 - 933. [Full Text] [PDF]
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R. Guerra, Z. Yu, S. Marcovina, R. Peshock, J. C. Cohen, and H. H. Hobbs Lipoprotein(a) and Apolipoprotein(a) Isoforms: No Association With Coronary Artery Calcification in The Dallas Heart Study Circulation, March 29, 2005; 111(12): 1471 - 1479. [Abstract] [Full Text] [PDF]
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 E. A Enas, A. Senthilkumar, C. Vinod, and N. Puthumana Dyslipidaemia among Indo-Asians strategies for identification and management The British Journal of Diabetes & Vascular Disease, March 1, 2005; 5(2): 81 - 90. [Abstract] [PDF]
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