Document Detail

Lipoprotein(a) levels and long-term cardiovascular risk in the contemporary era of statin therapy.
MedLine Citation:
PMID:  20601648     Owner:  NLM     Status:  MEDLINE    
Lipoprotein(a) [Lp(a)] has enhanced atherothrombotic properties. The ability of Lp(a) levels to predict adverse cardiovascular outcomes in patients undergoing coronary angiography has not been examined. The relationship between serum Lp(a) levels and both the extent of angiographic disease and 3-year incidence of major adverse cardiovascular events (MACE: death, myocardial infarction, stroke, and coronary revascularization) was investigated in 2,769 patients who underwent coronary angiography [median Lp(a) 16.4 mg/dl, elevated levels (≥30 mg/dl) in 38%]. An elevated Lp(a) was associated with a 2.3-fold [95% confidence interval (CI), 1.7-3.2, P < 0.001] greater likelihood of having a significant angiographic stenosis and 1.5-fold (95 CI, 1.3-1.7, P < 0.001) greater chance of three-vessel disease. Lp(a)≥30 mg/dl was associated with a greater rate of MACE (41.8 vs. 35.8%, P = 0.005), primarily due to a greater need for coronary revascularization (30.9 vs. 26.0%, P = 0.02). A relationship between Lp(a) levels and cardiovascular outcome was observed in patients with an LDL cholesterol (LDL-C) ≥70-100 mg/dl (P = 0.049) and >100 mg/dl (P = 0.02), but not <70 mg/dl (P = 0.77). Polymorphisms of Lp(a) were also associated with both plasma Lp(a) levels and coronary stenosis, but not a greater rate of MACE. Lp(a) levels correlate with the extent of obstructive disease and predict the need for coronary revascularization in subjects with suboptimal LDL-C control. This supports the need to intensify lipid management in patients with elevated Lp(a) levels.
Stephen J Nicholls; W H Wilson Tang; Heather Scoffone; Danielle M Brennan; Jaana Hartiala; Hooman Allayee; Stanley L Hazen
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural; Research Support, Non-U.S. Gov't     Date:  2010-07-02
Journal Detail:
Title:  Journal of lipid research     Volume:  51     ISSN:  0022-2275     ISO Abbreviation:  J. Lipid Res.     Publication Date:  2010 Oct 
Date Detail:
Created Date:  2010-09-10     Completed Date:  2011-01-24     Revised Date:  2012-05-07    
Medline Journal Info:
Nlm Unique ID:  0376606     Medline TA:  J Lipid Res     Country:  United States    
Other Details:
Languages:  eng     Pagination:  3055-61     Citation Subset:  IM    
Department of Cardiovascular Medicine, Cleveland Clinic, Cleveland, OH, USA.
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MeSH Terms
Cardiovascular Diseases / complications,  drug therapy*,  epidemiology*
Cholesterol, LDL / blood
Hydroxymethylglutaryl-CoA Reductase Inhibitors / therapeutic use*
Lipoprotein(a) / blood*
Polymorphism, Genetic
Risk Factors
Grant Support
1P01 HL098055-01/HL/NHLBI NIH HHS; 1R01 DK080732-01A1/DK/NIDDK NIH HHS; 1R01 HL103931-01/HL/NHLBI NIH HHS; P01 HL087018-020001/HL/NHLBI NIH HHS; P50 HL077107-050004/HL/NHLBI NIH HHS
Reg. No./Substance:
0/Cholesterol, LDL; 0/Hydroxymethylglutaryl-CoA Reductase Inhibitors; 0/Lipoprotein(a)

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