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Elevated Lipoprotein(a) and Premature Coronary Heart Disease

William B. Parsons Jr, MD
JAMA. 1997;277(3):209. doi:10.1001/jama.1997.03540270035012.
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To the Editor.  —Dr Bostom and colleagues1 have convincingly shown that elevated plasma Lp(a) is an independent risk factor for atherosclerotic disease, equal in power to elevated LDL or reduced high-density lipoprotein (HDL) cholesterol, according to guidelines set forth by the National Cholesterol Education Program.2 Clinicians are asking, "What is the practical importance? What can I do for my patients?" At least 1 news release said that nothing can be done to reduce Lp(a), which is incorrect.The only therapeutic measure that reduces Lp(a) is niacin.3 This is only 1 of several distinctive advantages of niacin not shared by diet or any other drug in current use. These include reducing total and LDL cholesterol levels, increasing HDL cholesterol levels, reducing triglyceride levels, and decreasing the incidence of myocardial infarction (MI), stroke, total mortality, cardiovascular surgery, cardiovascular hospitalization, and all hospitalization.4 Add to this the fact that niacin converts small


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