High lipoprotein(a) ups heart risk in women
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Very high levels of lipoprotein(a), measured by a state-of-the-art assay, are independently associated with an increased risk of cardiovascular events in healthy women, Boston-based investigators report.
The investigators note, however, that the finding does not “support generalized screening of lipoprotein(a) in the population as a whole, because only extremely high levels were associated with cardiovascular risk.” Moreover, most lipid-correcting therapies currently available have no effect on lipoprotein(a) concentrations.
Instead, they recommend that high-risk individuals with elevated levels of “bad” LDL cholesterol should be treated aggressively, with a statin or with niacin, when lipoprotein(a) levels are also high.
Dr. Jacqueline Suk Danik of Brigham and Women’s Hospital and her associates explain that lipoprotein(a) has been associated with heart disease, but its relevance as a biomarker has not been established, due at least in part to variability in assays.
Their aim was to clear up this controversy by using a new assay, validated and supported by the National Heart, Lung, and Blood Institute. In a prospective study, 27,791 initially healthy participants of the Women’s Health Study were evaluated. The WHS enrolled healthy women at least 45 years old between 1991 and 1995. The subjects were followed for 10 years.
Blood samples obtained at baseline and stored in liquid nitrogen were analyzed for lipoprotein(a) concentrations.
During follow up, 899 women suffered a nonfatal heart attack, nonfatal stroke, underwent coronary revascularization or died of a cardiac cause.
Analyses showed that women in the top 90th percentile of lipoprotein(a) levels (at least 65.5 mg/dL) had a significant excess risk of suffering a first-time cardiac event, compared with women with lower concentrations, independent of other traditional cardiac risk markers.
The highest rates of cardiac events occurred in women with lipoprotein(a) levels at or above the 90th percentile plus LDL cholesterol levels at or above the median (at least 124 mg/dL).
SOURCE: Journal of the American Medical Association, September 20, 2006.
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