To the Editor.
—Dr Bostom and colleagues in a prospective study1 report that elevated plasma Lp(a) is an independent risk factor for the development of premature coronary heart disease (CHD) in men. Lp(a) is a unique glycoprotein and may have variable and contrasting effects on different aspects of CHD. As the authors point out,1 previous studies have been inconclusive in demonstrating a clear link between elevated Lp(a) and risk of acute MI. Acute MI is attributed to the failure of spontaneous thrombolysis,2 and Lp(a) may influence the formation of coronary thrombus. However, an adverse effect of Lp(a) on the efficacy of thrombolytic therapy has not been reported, and, despite Lp(a) being a risk factor for CHD, its interactions during acute MI remain speculative.Thrombotic occlusion of the infarct-related coronary artery (IRCA) is often intermittent in the early, evolving phase of