title: Lipoprotein(a) and Increased Cardiovascular Risk in Women.
abstract: BACKGROUND
  Approximately 20% of the population has elevated circulating levels of lipoprotein(a) (Lp[a]), one of the most robust predictors of cardiovascular disease risk. This is particularly true for women.
  
  
  OBJECTIVE
  Many female patients with "normal" traditional risk factors or low atherosclerotic cardiovascular disease (ASCVD) risk scores may harbor high risk related to elevated levels of Lp(a).
  
  
  METHODS
  A retrospective, cross-sectional study of consecutive female patients presenting to Heart Centers for Women was performed. Discordance between low-density lipoprotein cholesterol (LDL-C) and Lp(a) was determined. The ASCVD risk and Reynolds Risk Score models A (RRS-A) and B (RRS-B) were calculated, and level of agreement in patients meeting treatment threshold (≥7.5% for ASCVD, ≥10% for RRS-A and RRS-B) were compared.
  
  
  RESULTS
  Among 713 women, 290 (41%) had elevated Lp(a); however, LDL-C and Lp(a) were weakly correlated (r = 0.08). Significant discordance was observed between abnormal LDL-C and Lp(a) levels (McNemar P = 0.03). There was moderate correlation between RRS-A and ASCVD risk (r = 0.71, P < 0.001), and Bland-Altman plot showed diminished correlation with increased risk. More patients met treatment threshold by ASCVD risk estimation, but nearly 1 out of 20 patients met treatment threshold by RRS-A but not ASCVD score.
  
  
  CONCLUSIONS
  There is high prevalence of elevated Lp(a) among women presenting to Heart Centers for Women. Although traditional risk markers such as elevated LDL-C or high ASCVD risk may be absent in some women, elevated Lp(a) may identify patients who may benefit from aggressive risk-factor modification and pharmacologic therapy.
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Briana T
authors.initials: BT
authors.lastname: Costello
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Eric R
authors.initials: ER
authors.lastname: Silverman
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.|Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
authors.forename: Rami
authors.initials: R
authors.lastname: Doukky
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Lynne T
authors.initials: LT
authors.lastname: Braun
authors.affiliation: Division of Neurology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Neelum T
authors.initials: NT
authors.lastname: Aggarwal
authors.affiliation: Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Youping
authors.initials: Y
authors.lastname: Deng
authors.affiliation: Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
authors.forename: Yan
authors.initials: Y
authors.lastname: Li
authors.affiliation: Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.
authors.forename: Gina
authors.initials: G
authors.lastname: Lundberg
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Kim A
authors.initials: KA
authors.lastname: Williams
authors.affiliation: Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
authors.forename: Annabelle S
authors.initials: AS
authors.lastname: Volgman
mesh_terms: D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000175:diagnosis / Q000453:epidemiology*; D002641:Chicago / Q000453:epidemiology; D008078:Cholesterol, LDL / Q000097:blood; D003430:Cross-Sectional Studies; D050171:Dyslipidemias / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology*; D005260:Female; D005845:Georgia / Q000453:epidemiology; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008875:Middle Aged; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D012737:Sex Factors; D015854:Up-Regulation
chemical_list: D015415:Biomarkers; D008078:Cholesterol, LDL; D017270:Lipoprotein(a)