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Is lipoprotein(a) an independent risk factor for ischemic heart disease in men? The Quebec Cardiovascular Study
B Cantin1, F Gagnon, S Moorjani
1Lipid Research Centre, Laval University Medical Centre and Faculty of Medicine, Laval University, Ste-Foy, Quebec, Canada. CLajoie@sympatico.ca
Insights
Lipoprotein(a) [Lp(a)] did not independently predict ischemic heart disease (IHD). However, elevated Lp(a) appeared to worsen risks from other lipid factors like LDL cholesterol.
Area of Science:
- Cardiovascular Medicine
- Lipidology
- Preventive Cardiology
Background:
- Elevated lipoprotein(a) [Lp(a)] concentrations are suspected risk factors for ischemic heart disease (IHD).
- Previous research findings are inconsistent, and few studies have been prospective.
Purpose of the Study:
- To determine if lipoprotein(a) [Lp(a)] is an independent risk factor for ischemic heart disease (IHD).
- To examine the relationship between Lp(a) and other lipid fractions in predicting IHD risk.
Main Methods:
- A 5-year prospective follow-up of 2,156 French Canadian men aged 47-76 without existing IHD.
- Baseline measurements included total cholesterol, LDL, HDL, apoprotein B, and Lp(a).
- Adjusted proportional hazards models analyzed IHD event risks and Lp(a) interactions with lipid factors.
Main Results:
- Lipoprotein(a) [Lp(a)] was not identified as an independent risk factor for ischemic heart disease (IHD).
- Elevated Lp(a) appeared to amplify the adverse effects of high LDL cholesterol, total cholesterol, and apoprotein B.
- Elevated Lp(a) seemed to diminish the protective effects of high HDL cholesterol.
Conclusions:
- In this cohort, lipoprotein(a) [Lp(a)] is not an independent predictor of ischemic heart disease (IHD).
- Lp(a) may modify the risk associated with other established lipid risk factors, potentially increasing overall cardiovascular risk.
Objectives:
This study was undertaken to determine whether lipoprotein(a) [Lp(a)] is an independent risk factor for ischemic heart disease (IHD) and to establish the relation of Lp(a) to the other lipid fractions.
Background:
Several, but not all, studies have shown that elevated Lp(a) concentrations may be associated with IHD; very few have been prospective.
Methods:
A 5-year prospective follow-up study was conducted in 2,156 French Canadian men 47 to 76 years old, without clinical evidence of IHD. Lipid measurements obtained at baseline included total cholesterol, low density lipoprotein (LDL) cholesterol, high density lipoprotein (HDL) cholesterol, apoprotein B and Lp(a). During the follow-up period, there were 116 first IHD events (myocardial infarction, angina, death). Adjusted proportional hazards models were used to estimate the relative risk for the different variables. The cohort was also classified according to Lp(a) levels and other lipid risk factor tertiles to evaluate the relation of elevated Lp(a) levels to these risk factors. A cutoff value of 30 mg/dl was used for Lp(a). Risk ratios were calculated using the group with low Lp(a) levels and the first tertile of lipid measures as a reference.
Results:
Lp(a) was not an independent risk factor for IHD but seemed to increase the deleterious effects of mildly elevated LDL cholesterol and elevated total cholesterol and apoprotein B levels and seemed to counteract the beneficial effects associated with elevated HDL cholesterol levels.
Conclusions:
In this cohort, Lp(a) was not an independent risk factor for IHD but appeared to increase the risk associated with other lipid risk factors.
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