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Lipoprotein (a) and coronary heart disease risk: a nested case-control study of the Helsinki Heart Study participants
M Jauhiainen1, P Koskinen, C Ehnholm
1National Public Health Institute, Helsinki, Finland.
Insights
Serum lipoprotein(a) (Lp(a)) levels did not predict future coronary heart disease events in a 5-year study of middle-aged men. This finding suggests Lp(a) may not be a reliable biomarker for cardiovascular risk in this population.
Area of Science:
- Cardiology
- Biomarkers
- Epidemiology
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Lipoprotein(a) (Lp(a)) has been investigated as a potential independent risk factor for CHD.
- Previous studies have yielded conflicting results regarding the predictive value of Lp(a) for cardiovascular events.
Purpose of the Study:
- To prospectively evaluate the association between serum lipoprotein(a) (Lp(a)) concentrations and the risk of developing coronary heart disease (CHD).
- To assess Lp(a) as a predictor of major adverse cardiovascular events in a well-defined cohort of middle-aged men.
Main Methods:
- Prospective cohort study involving 4081 men aged 40-55 without baseline CHD.
- Serum Lp(a) levels were measured by immunoassay in 130 subjects with coronary events and 138 controls.
- Samples were stored at -20°C for up to 8.5 years, with stability studies confirming no significant degradation.
- Statistical analysis compared Lp(a) levels between cases and controls, adjusting for other cardiovascular risk factors.
Main Results:
- No significant differences were observed in the distribution, mean, or median serum Lp(a) concentrations between men who experienced coronary events and the control group.
- Neither blood pressure nor total cholesterol were significant predictors of events, though LDL cholesterol was higher in the event group.
- Lp(a) levels measured in fresh samples also showed no significant difference between myocardial infarction survivors and controls.
Conclusions:
- Serum lipoprotein(a) (Lp(a)) levels were not found to be a predictor of future coronary events in the Helsinki Heart Study cohort.
- These findings indicate that Lp(a) may not play a significant role in predicting cardiovascular risk in this specific population of middle-aged men.
- Further research may be warranted to explore Lp(a)'s role in diverse populations and its interaction with other risk factors.
Abstract:
To prospectively assess the role of lipoprotein(a) (Lp(a)) as a risk factor for coronary heart disease, the serum Lp(a) concentration was determined in 130 subjects without coronary events and in 138 patients in whom coronary events (i.e. fatal and non-fatal myocardial infarction and cardiac death) occurred during the 5-year Helsinki Heart Study. The participants of this study (n = 4081) were 40-55-year-old men who were devoid of coronary heart disease at the beginning of the trial; half were randomized to gemfibrozil and the other half to placebo treatment. In patients with coronary events blood pressure and total cholesterol were not significant predictors of the events but their LDL cholesterol was higher than compared to the control group in this cohort (P less than 0.05). The serum Lp(a) concentration was determined by immunoassay from samples obtained 3 months after the beginning of the trial and then stored at -20 degrees C until analysed. Studies on the effect of long term storage at -20 degrees C on serum Lp(a) levels did not reveal significant changes in Lp(a) concentration in sera stored for up to 8.5 years. The distribution of Lp(a) concentrations were similar in the men with coronary events and the controls. Nor did the mean or median levels of Lp(a) differ significantly between the two groups. Measurements of Lp(a) levels in fresh samples using 2 different immunoassays did not reveal any significant difference between the participants who had survived a myocardial infarction or participants without cardiac events. Thus, we conclude that in the Helsinki Heart Study cohort the serum Lp(a) level was not a predictor of future coronary events.