title: Lipoprotein (a): perspectives from a lipid-referral program.
abstract: BACKGROUND
  Lipoprotein (a) [Lp(a)] has a strong association with coronary disease (CHD). We evaluated the implications of implementing a niacin strategy in persons above low risk by the Framingham risk score (FRS).
  
  
  METHODS
  Patients referred to a university lipid management program from January 2004 to June 2010 had an Lp(a) level measured at initial evaluation. Factors associated with an increase in Lp(a) and predictors of a high risk Lp(a) (≥50 mg/dL) were assessed. FRS and Lp(a) levels were used to assess eligibility for niacin with an Lp(a) ≥50 mg/dL.
  
  
  RESULTS
  A total of 692 patients (57% male, mean age 52 ± 14 years) had a mean Lp(a) of 32 ± 40 mg/dL. In a multiple logistic regression model, African-American race, female gender, presence of CHD, and lower triglyceride levels were significant predictors of high risk Lp(a). Ten percent were determined to be intermediate and 44% high risk by FRS. A total of 9% of intermediate- and 26% of high-risk patients had an Lp(a) ≥50 mg/dL, and 84% were not taking niacin. A total of 19% of moderate- and high-risk patients were eligible for initiation of niacin based upon values ≥50 mg/dL. If niacin were also used for an high-density lipoprotein cholesterol levels ≤40 mg/dL, only 5.1% additional patients would require niacin.
  
  
  CONCLUSIONS
  High-risk levels of Lp(a) are associated with female gender, African- American race, and CHD. 19% of moderate and high risk patients would be candidates for treatment with niacin if the indication is a cutpoint Lp(a) ≥50 mg/dL.
authors.affiliation: Division of Cardiovascular Medicine, University of Michigan, 24 Frank Lloyd Wright Drive, PO Box 322, Ann Arbor, MI 48188, USA. mrubenfi@umich.edu
authors.forename: Melvyn
authors.initials: M
authors.lastname: Rubenfire
authors.forename: Deepthi
authors.initials: D
authors.lastname: Vodnala
authors.forename: Sangeetha M
authors.initials: SM
authors.lastname: Krishnan
authors.forename: Robert L
authors.initials: RL
authors.lastname: Bard
authors.forename: Elizabeth A
authors.initials: EA
authors.lastname: Jackson
authors.forename: Donald
authors.initials: D
authors.lastname: Giacherio
authors.forename: Robert D
authors.initials: RD
authors.lastname: Brook
mesh_terms: D000328:Adult; D000368:Aged; D002986:Clinical Trials as Topic; D003327:Coronary Disease / Q000188:drug therapy / Q000209:etiology; D005260:Female; D006801:Humans; D006951:Hyperlipoproteinemias / Q000097:blood / Q000150:complications / Q000188:drug therapy; D000960:Hypolipidemic Agents / Q000627:therapeutic use; D017270:Lipoprotein(a) / Q000097:blood*; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009525:Niacin / Q000627:therapeutic use; D017410:Practice Guidelines as Topic; D012017:Referral and Consultation; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors
chemical_list: D000960:Hypolipidemic Agents; D017270:Lipoprotein(a); D009525:Niacin