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Lipoprotein (a) and coronary heart disease: a prospective case-control study in a general population sample of middle
A Rosengren1, L Wilhelmsen, E Eriksson
1Department of Medicine, Ostra Hospital, University of Gothenburg, Sweden.
Insights
Elevated serum lipoprotein (a) levels in middle-aged men are linked to a higher risk of coronary heart disease. This finding highlights lipoprotein (a) as an independent predictor of heart attacks and related deaths.
Area of Science:
- Cardiovascular Research
- Biomarkers
- Epidemiology
Background:
- Coronary heart disease (CHD) remains a leading cause of mortality worldwide.
- Identifying novel risk factors is crucial for effective prevention strategies.
- Lipoprotein (a) [Lp(a)] is an established, yet not fully understood, cardiovascular risk marker.
Purpose of the Study:
- To investigate the association between serum lipoprotein (a) concentration and the incidence of coronary heart disease.
- To determine if Lp(a) is an independent risk factor for myocardial infarction (MI) and CHD-related mortality.
Main Methods:
- A prospective case-control study was conducted with a six-year follow-up.
- Serum samples from 776 men aged 50 at baseline were analyzed for Lp(a) concentrations.
- Cases (26 men with MI or CHD death) were compared to 109 matched controls without prior MI.
Main Results:
- Men who experienced CHD had significantly higher serum Lp(a) concentrations compared to controls.
- The highest quintile of Lp(a) was associated with more than double the rate of CHD.
- Logistic regression confirmed Lp(a) as an independent predictor of CHD, even after accounting for other risk factors.
Conclusions:
- Serum Lp(a) concentration is an independent risk factor for myocardial infarction and death from coronary heart disease in middle-aged men.
- Lp(a) may serve as a valuable biomarker for stratifying cardiovascular risk.
- Further research into the mechanisms and clinical management of elevated Lp(a) is warranted.
Objective:
To examine the association between the serum lipoprotein (a) concentration and subsequent coronary heart disease.
Design:
Prospective case-control study based on a six year follow up of a general population sample of men aged 50 at baseline in 1983-4. Serum samples were frozen at the time of the baseline examination and kept at -70 degrees C for six years, after which the lipoprotein (a) concentrations in the samples were measured in cases and controls.
Setting:
City of Gothenburg, Sweden.
Subjects:
26 Men, from a general population sample of 776 men, who had sustained a myocardial infarction or died of coronary heart disease during the six years and 109 randomly selected controls from the same sample who had remained free of myocardial infarction. In neither cases nor controls was there a history of myocardial infarction at baseline.
Main Outcome Measures:
Proportion of myocardial infarction or deaths from coronary heart disease, or both, in relation to the serum lipoprotein (a) concentration.
Results:
Men who suffered coronary heart disease had significantly higher serum lipoprotein (a) concentrations than controls (mean difference 105 mg/l; 95% confidence interval 18 to 192 mg/l). Men with the highest fifth of serum lipoprotein (a) concentrations (cut off point 365 mg/l) suffered a coronary heart disease rate which was more than twice that of men with the lowest four fifths of concentrations. Logistic regression analysis showed the serum lipoprotein (a) concentration to be significantly associated with coronary heart disease independently of other risk factors.
Conclusion:
The serum lipoprotein (a) concentration in middle aged men is an independent risk factor for subsequent myocardial infarction or death from coronary heart disease.