title: Low lipoprotein(a) concentration is associated with cancer and all-cause deaths: a population-based cohort study (the JMS cohort study).
abstract: BACKGROUND
  Experimental studies support the anti-neoplastic effect of apo(a), but several clinical studies have reported contradictory results. The purpose of this study was to determine whether a low lipoprotein(a) [Lp(a)] concentration is related to mortality from major causes of death, especially cancer.
  
  
  METHODS
  The subjects were 10,413 participants (4,005 men and 6,408 women) from a multi-center population-based cohort study in Japan (The Jichi Medical School cohort study). The average age at registration was 55.0 years, and the median observation period was 4,559 days. As the estimated hazard ratio was high for both the low and very high Lp(a) levels, we defined two Lp(a) groups: a low Lp(a) group [Lp(a)<80 mg/L] and an intermediate-to-high Lp(a) group [Lp(a) ≥ 80]. Participants who died from malignant neoplasms (n = 316), cardiovascular disease (202), or other causes (312) during the observation period were examined.
  
  
  RESULTS
  Cumulative incidence plots showed higher cumulative death rates for the low Lp(a) group than for the intermediate-to-high Lp(a) group for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.03, and p = 0.03, respectively). Cox proportional hazards analyses with the sex and age of the participants, body mass index, and smoking and drinking histories as covariates showed that a low Lp(a) level was a significant risk for all-cause, cancer, and miscellaneous-cause deaths (p<0.001, p = 0.003, and p = 0.01, respectively). The hazard ratio (95% CI) [1.48, 1.15-1.92] of a low Lp(a) level for cancer deaths was almost the same as that for a male sex (1.46, 1.00-2.13).
  
  
  CONCLUSIONS
  This is the first report to describe the association between a low Lp(a) level and all-cause or cancer death, supporting the anti-neoplastic effect of Lp(a). Further epidemiological studies are needed to confirm the present results.
authors.affiliation: Bioresource Center for Geriatric Research, Tokyo Metropolitan Geriatric Hospital, Tokyo, Japan.
authors.forename: Motoji
authors.initials: M
authors.lastname: Sawabe
authors.forename: Noriko
authors.initials: N
authors.lastname: Tanaka
authors.forename: Makiko Naka
authors.initials: MN
authors.lastname: Mieno
authors.forename: Shizukiyo
authors.initials: S
authors.lastname: Ishikawa
authors.forename: Kazunori
authors.initials: K
authors.lastname: Kayaba
authors.forename: Ken-ichi
authors.initials: K
authors.lastname: Nakahara
authors.forename: Satoru
authors.initials: S
authors.lastname: Matsushita
mesh_terms: D000328:Adult; D000368:Aged; D004198:Disease Susceptibility / Q000097:blood / Q000401:mortality; D005260:Female; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009369:Neoplasms / Q000097:blood / Q000401:mortality*; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012307:Risk Factors; D012577:Schools, Medical; D018709:Statistics, Nonparametric; D016019:Survival Analysis
chemical_list: D017270:Lipoprotein(a)