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Letters | October 21, 2009

Lipoprotein(a) Measurement and Determining Risk of Myocardial Infarction

Steven R. Jones, MD; Roger S. Blumenthal, MD

JAMA. 2009;302(15):1645-1646. doi:10.1001/jama.2009.1483.

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To the Editor: Dr Kamstrup and colleagues¹ assessed the association between elevated lipoprotein(a) and risk of myocardial infarction using data from the Copenhagen General Population Study (CGPS), the Copenhagen City Heart Study, and the Copenhagen Ischemic Heart Disease Study. We believe that several limitations were not adequately addressed in their article.

Measurement of lipoprotein(a) levels in the CGPS began before the IFCC/WHO consensus on lipoprotein(a) and the SRM-2B reference reagent study² leading to adoption of lipoprotein(a) measurement as a molar particle concentration (lipoprotein[a]-P), independent of apolipoprotein(a) kringle IV type 2 repeat isoform. The values of lipoprotein(a) in the CGPS are based on an assay determining lipoprotein(a) mass and are subject to bias by apolipoprotein(a) molecular weight. Comparison with current isoform-independent molar assays confirms substantial bias with the older methods.² The generalizability of the CGPS lipoprotein(a) serum level and lipoprotein(a) population percentile data to current lipoprotein(a) molar serum assays may be limited by the differences in measurement methodology.

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October 21, 2009

Lipoprotein(a) Measurement and Determining Risk of Myocardial Infarction—Reply

Pia R. Kamstrup, MD, PhD; Børge G. Nordestgaard, MD, DMSc

JAMA. 2009;302(15):1645-1646. doi:10.1001/jama.2009.1484.

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Jones SR, Blumenthal RS. Lipoprotein(a) Measurement and Determining Risk of Myocardial Infarction. JAMA. 2009;302(15):1645-1646. doi:10.1001/jama.2009.1483.

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