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Lipoprotein (a) as a predictor of myocardial infarction in middle-aged men
M Seed1, K L Ayres, S E Humphries
1Department of Vascular Medicine (MS), Charing Cross Hospital, National Heart and Lung Institute Division of Imperial College School of Medicine, England, London, United Kingdom.
Insights
High lipoprotein (a) [Lp(a)] levels are an independent risk factor for coronary heart disease. This prospective study in middle-aged men confirms Lp(a) as a significant predictor of heart events.
Area of Science:
- Cardiology
- Preventive Medicine
- Biomarkers
Background:
- The role of serum lipoprotein (a) [Lp(a)] as an independent risk factor for coronary heart disease (CHD) remains debated.
- Investigating Lp(a) is crucial for understanding and preventing cardiovascular disease.
Purpose of the Study:
- To determine if serum Lp(a) levels are an independent risk factor for CHD.
- To analyze Lp(a) status in a prospective population survey, the Second Northwick Park Heart Study.
Main Methods:
- Recruited 2,616 men aged 50-61 years in the UK.
- Measured baseline serum Lp(a) using ELISA, categorizing levels into three groups.
- Followed participants for a mean of 6 years, recording coronary events like sudden cardiac death and myocardial infarction.
Main Results:
- Identified multiple independent risk factors for coronary events, including cholesterol, diabetes, smoking, blood pressure, Apo-A1, age, and Lp(a).
- A statistically significant association was found between higher Lp(a) levels and increased risk of coronary events (P = 0.01).
- Men in the highest Lp(a) group (>75th percentile) had a 1.9-fold increased risk (95% CI: 1.1 to 3.3) compared to the lowest group (<25th percentile).
Conclusions:
- High serum Lp(a) levels are confirmed as an independent predictor of coronary heart disease development.
- Findings are significant for middle-aged men, highlighting Lp(a) as a target for cardiovascular risk assessment.
Purpose:
Whether serum lipoprotein (a) [Lp(a)] levels are an independent risk factor for coronary heart disease has been controversial. We have investigated its status in a prospective population survey, the Second Northwick Park Heart Study.
Methods:
We recruited 2,616 men 50 to 61 years old from nine primary care practices in the United Kingdom. Baseline serum Lp(a) levels were measured by enzyme-linked immunosorbent assay (ELISA) and were analyzed in 3 groups (<25th percentile, 25th to 75th percentile, and >75th percentile) to overcome the problem of some measurements falling below the threshold of the assay. Coronary end points included sudden cardiac death, acute myocardial infarction, silent myocardial infarction on the electrocardiogram, and coronary artery bypass surgery.
Results:
During a mean of 6 years of follow-up, 121 men had coronary events. In a multivariate analysis that also adjusted for fibrinogen, Apo-A1, Apo-B, and triglyceride levels, we identified several independent risk factors for coronary events, including cholesterol level (hazard ratio [HR] = 1.5 per SD 95% confidence interval [CI] 1.3 to 1.8), diabetes (HR = 4.1, 95% CI: 2. 0 to 8.4), current versus never smoking (HR = 2.5, 95% CI: 1.5 to 4.1), diastolic blood pressure (HR = 1.4 per SD, 95% CI: 1.1 to 1.7), Apo-A1 (HR = 0.8 per SD, 95% CI: 0.6 to 0.9), age (HR = 1.3 per SD, 95% CI: 1.1 to 1.6), and Lp(a) (>26.3 mg/dL [75th percentile] versus <2.9 mg/dL [25th percentile], HR = 1.9, 95% CI: 1.1 to 3.3]. There was a statistically significant (P = 0.01) difference in risk between the three levels of Lp(a).
Conclusions:
We found that a high Lp(a) level was an independent predictor of the development of coronary heart disease in middle-aged men.