Lp(a) lipoprotein is a major risk factor for cardiovascular disease: pathogenic mechanisms and clinical significance.
The results of two previous and two recent studies of middle-aged males and females are presented to exemplify the clinical importance of lipoprotein(a) (Lp(a)) as a risk factor for atherosclerosis and coronary heart disease. In these studies various conventional and recently suggested risk factors were included and different methods for Lp(a) quantification were used. Lp(a) was a significant risk factor in all four studies. In the recent prospective case-control study, Lp(a) and cholesterol were found to act synergistically and predict primary acute myocardial infarction in Swedish males. A cholesterol level above 6.5 mmol/l increased the risk of acute myocardial infarction if the Lp(a) level was above 200 mg/l. The plasma apo A-I level was a protective factor. In the other recent case-control study, an Lp(a) level above 500 mg/l was a highly significant risk factor in Black and White US women with myocardial infarction or advanced coronary artery disease in addition to low density lipoprotein cholesterol levels above 130 mg/dl. A high apo A-I level was a protective factor. In these studies no other factors tested reached significance in multivariate logistic regression analysis. A hypothetical association between high Lp(a) levels and intracellular infection with Chlamydia pneumoniae is discussed. The results suggest that the Lp(a) level is useful in identifying high-risk individuals. Lowering low density lipoprotein cholesterol below 100 mg/dl (<2.6 mmol/l) seems to be most important in both males and females with high-risk Lp(a) levels.
Dahlén
G H
GH
Department of Clinical Chemistry, University of Umeå, Sweden.
Stenlund
H
H
D000328:Adult; D000368:Aged; D001161:Arteriosclerosis / Q000209:etiology; D044383:Black People; D002318:Cardiovascular Diseases / Q000209:etiology / Q000503:physiopathology*; D016022:Case-Control Studies; D016993:Chlamydophila pneumoniae / Q000472:pathogenicity; D008078:Cholesterol, LDL / Q000097:blood; D005260:Female; D006801:Humans; D008055:Lipids / Q000097:blood; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D008954:Models, Biological; D009203:Myocardial Infarction / Q000503:physiopathology; D011446:Prospective Studies; D012044:Regression Analysis; D012307:Risk Factors; D013548:Sweden; D014481:United States; D044465:White People; D001741:Black or African American
D008078:Cholesterol, LDL; D008055:Lipids; D017270:Lipoprotein(a)