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February 26, 1992, Vol 267, No. 8 >
ARTICLE | February 26, 1992

Lipoprotein(a): Title and subTitle BreakClinical Approach to a Unique Atherogenic Lipoprotein FREE

Daniel J. Rader, MD; H. Bryan Brewer, Jr, MD
JAMA. 1992;267(8):1109-1112. doi:10.1001/jama.1992.03480080079031
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References

SELECTED CASE  A 42-YEAR-OLD man was referred because of premature coronary artery disease (CAD). He had been healthy until 3 months earlier, when he sustained a non—Q wave myocardial infarction. Cardiac catheterization revealed severe triple-vessel coronary disease, and he underwent coronary artery bypass grafting. He was not a smoker and had no history of diabetes mellitus or hypertension. Family history was remarkable for a father who died of an acute myocardial infarction at the age of 54 years. Three weeks after surgery, a random serum cholesterol level was 5.38 mmol/L.Physical examination of the patient at the National Institutes of Health revealed no corneal arcus, normal liver and spleen size, and no evidence of palmar, tuberoeruptive, or tendon xanthomas. Laboratory values included a normal fasting blood glucose, normal serum urea nitrogen, and normal serum tests of liver and thyroid function. Fasting plasma lipid and lipoprotein values included the following: triglycerides,

REFERENCES

1 +
Berg K.  A new serum type system in man: the Lp system. Acta Pathol Microbiol Scand . 1963;;59:369-382.
2 +
Utermann G.  The mysteries of lipoprotein (a). Science . 1989;;246:904-910.
3 +
Mbewu AD, Durrington PN.  Lipoprotein(a): structure, properties, and possible involvement in thrombogenesis and atherogenesis. Atherosclerosis . 1990;;85:1-14.
4 +
Rosengren A, Wilhelmsen L, Eriksson E, Risberg B, Wedel H.  Lipoprotein (a) and coronary heart disease: a prospective case-control study in a general population sample of middle-aged men. BMJ . 1990;;301:1248-1251.
5 +
Dahlen GH, Guyton JR, Attar M, Farmer JA, Kautz JA, Gotto AM Jr.  Association of levels of lipoprotein Lp(a), plasma lipids, and other lipoproteins with coronary artery disease documented by angiography. Circulation . 1986;;74:758-765.
6 +
Armstrong VW, Cremer P, Eberle E, et al.  The association between serum Lp(a) concentrations and angiographically assessed coronary atherosclerosis: dependence on serum LDL levels. Atherosclerosis . 1986;;62:249-257.
7 +
Zenker G, Koltringer P, Bone G, Niederkorn K, Pfeiffer K, Jurgens G.  Lipoprotein(a) as a strong indicator for cerebrovascular disease. Stroke . 1986;;17:942-945.
8 +
Hoff HF, Beck GJ, Skibinski CI, et al.  Serum Lp(a) level as a predictor of vein graft stenosis after coronary artery bypass surgery in patients. Circulation . 1988;;77:1238-1244.
9 +
Scanu AM, Fless GM.  Lipoprotein (a): heterogeneity and biological relevance. J Clin Invest . 1990;;85:1709-1715.
10 +
Utermann G, Menzel HJ, Kraft HG, Duba HC, Kemmler HG, Seitz C.  Lp(a) glycoprotein phenotypes: inheritance and relation to Lp(a)-lipoprotein concentrations in plasma. J Clin Invest . 1987;;80:458-465.
11 +
McLean JW, Tomlinson JE, Kuang WJ, et al.  cDNA sequence of human apolipoprotein(a) is homologous to plasminogen. Nature . 1987;;330:132-137.
12 +
Lackner C, Boerwinkle E, Leffert CC, Rahmig T, Hobbs HH.  Molecular basis of apolipoprotein (a) isoform size heterogeneity as revealed by pulsed-field gel electrophoresis. J Clin Invest . 1991;;87:2153-2161.
13 +
Rath M, Niendorf A, Reblin T, Dietel M, Krebber HJ, Beisiegel U.  Detection and quantification of lipoprotein(a) in the arterial wall of 107 coronary bypass patients. Arteriosclerosis . 1989;;9:579-592.
14 +
Cushing GL, Gaubatz JW, Nava ML, et al.  Quantitation and localization of apolipoproteins (a) and B in coronary artery bypass vein grafts resected at re-operation. Arteriosclerosis . 1989;;9:593-603.
15 +
Nachman RL, Gavish D, Azrolan N, Clarkson TB.  Lipoprotein (a) in diet-induced atherosclerosis in nonhuman primates. Arteriosclerosis Thromb . 1991;;11:32-38.
16 +
Loscalzo J.  Lipoprotein(a): a unique risk factor for atherothrombotic disease. Arteriosclerosis . 1990;; 10:672-679.
17 +
Miles LA, Plow EF.  Lp(a): an interloper in the fibrinolytic system. Thromb Haemost . 1990;;63:331-335.
18 +
Rader DJ, Cain W, Zech LA, Kindt M, Usher D, Brewer HB Jr.  Lp(a): plasma levels in individuals with the same apo(a) isoprotein are determined by differences in production rates. Circulation . 1991;;84:565.
19 +
Utermann G, Hoppichler F, Dieplinger H, Seed M, Thompson G, Boerwinkle E.  Defects in the low density lipoprotein receptor gene affect lipoprotein (a) levels: multiplicative interaction of two gene lociassociated with premature atherosclerosis. Proc Natl Acad Sci U S A . 1989;;86:4171-4174.
20 +
Soutar AK, McCarthy SN, Seed M, Knight BL.  Relationship between apolipoprotein(a) phenotype, lipoprotein(a) concentration in plasma, and low density lipoprotein receptor function in a large kindred with familial hypercholesterolemia due to the pro664 to leu mutation in the LDL receptor gene. J Clin Invest . 1991;;88:483-492.
21 +
Seed M, Hoppichler F, Reaveley D, et al.  Relation of serum lipoprotein(a) concentration and apolipoprotein(a) phenotype to coronary heart disease in patients with familial hypercholesterolemia. N Engl J Med . 1990;;322:1494-1499.
22 +
Mann WA, Kraft HG, Rader DJ, et al.  Human in vivo catabolism of lipoprotein(a). Circulation . 1989;;80:II-181.
23 +
Hofmann SL, Eaton DL, Brown MS, McConathy WJ, Goldstein JL, Hammer RE.  Overexpression of human low density lipoprotein receptors leads to accelerated catabolism of Lp(a) lipoprotein in transgenic mice. J Clin Invest . 1990;;85:1542-1547.
24 +
Parra HJ, Mezdour H, Cachera C, Dracon M, Tacquet A, Fruchart JC.  Lp(a) lipoprotein in patients with chronic renal failure treated by hemodialysis. Clin Chem . 1987;;33:721.
25 +
Jenkins AJ, Steele JS, Janus ED, Best JD.  Increased plasma apolipoprotein(a) levels in IDDM patients with microalbuminuria. Diabetes . 1991;;40:787-790.
26 +
Sandkamp M, Assmann G.  Lipoprotein(a) in PROCAM participants and young myocardial infarction survivors.  In: Scanu AM, ed. Lipoprotein(a) . New York, NY: Academic Press; 1990;:205-209.
27 +
Meilahn EN, Kuller LH, Matthews KA, Stein EA.  Lp(a) concentrations among pre- and post-menopausal women over time: the Healthy Women Study. Circulation . 1991;;84:546.
28 +
Kervinen K, Savolainen MJ, Kesaniemi YA.  A rapid increase in lipoprotein (a) levels after ethanol withdrawal in alcoholic men. Life Sci . 1991;;48:2183-2188.
29 +
Albers JJ, Marcovina SM, Lodge MS.  The unique lipoprotein(a): properties and immunochemical measurement. Clin Chem . 1990;;36:2019-2026.
30 +
Hellsten G, Boman K, Hallmans G, Dahlen G.  Lipids and endurance physical activity. Atherosclerosis . 1989;;75:93-94.
31 +
Brewer HB Jr.  Effectiveness of diet and drugs in the treatment of patients with elevated Lp(a) levels.  In: Scanu AM, ed. Lipoprotein(a) . New York, NY: Academic Press; 1990;:211-220.
32 +
Kostner GM.  The physiological role of Lp(a).  In: Scanu AM, ed. Lipoprotein(a) . New York, NY: Academic Press; 1990;:183-204.
33 +
Carlson LA, Hamsten A, Asplund A.  Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid. J Intern Med . 1989;;226:271-276.
34 +
Gurakar A, Hoeg JM, Kostner G, Papadopoulos NM, Brewer HB Jr.  Levels of lipoprotein Lp(a) decline with neomycin and niacin treatment. Atherosclerosis . 1985;;57:293-301.
35 +
Brown G, Albers JJ, Fisher SM, et al.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med . 1990;;323:1289-1298.
36 +
Hoeg JM, Gregg RE, Brewer HB Jr.  An approach to the management of hyperlipoproteinemia. JAMA . 1986;;255:512-521.
37 +
Soma M, Fumagalli R, Paoletti R, et al.  Plasma Lp(a) concentration after oestrogen and progestagen in postmenopausal women. Lancet . 1991;;337:612. Letter.
38 +
Mosca L, Bowlin S, Davidson L, Jenkins P, Pearson TA.  Estrogen replacement therapy and lipoprotein (a). Circulation . 1991;;84:546.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Berg K.  A new serum type system in man: the Lp system. Acta Pathol Microbiol Scand . 1963;;59:369-382.
2 +
Utermann G.  The mysteries of lipoprotein (a). Science . 1989;;246:904-910.
3 +
Mbewu AD, Durrington PN.  Lipoprotein(a): structure, properties, and possible involvement in thrombogenesis and atherogenesis. Atherosclerosis . 1990;;85:1-14.
4 +
Rosengren A, Wilhelmsen L, Eriksson E, Risberg B, Wedel H.  Lipoprotein (a) and coronary heart disease: a prospective case-control study in a general population sample of middle-aged men. BMJ . 1990;;301:1248-1251.
5 +
Dahlen GH, Guyton JR, Attar M, Farmer JA, Kautz JA, Gotto AM Jr.  Association of levels of lipoprotein Lp(a), plasma lipids, and other lipoproteins with coronary artery disease documented by angiography. Circulation . 1986;;74:758-765.
6 +
Armstrong VW, Cremer P, Eberle E, et al.  The association between serum Lp(a) concentrations and angiographically assessed coronary atherosclerosis: dependence on serum LDL levels. Atherosclerosis . 1986;;62:249-257.
7 +
Zenker G, Koltringer P, Bone G, Niederkorn K, Pfeiffer K, Jurgens G.  Lipoprotein(a) as a strong indicator for cerebrovascular disease. Stroke . 1986;;17:942-945.
8 +
Hoff HF, Beck GJ, Skibinski CI, et al.  Serum Lp(a) level as a predictor of vein graft stenosis after coronary artery bypass surgery in patients. Circulation . 1988;;77:1238-1244.
9 +
Scanu AM, Fless GM.  Lipoprotein (a): heterogeneity and biological relevance. J Clin Invest . 1990;;85:1709-1715.
10 +
Utermann G, Menzel HJ, Kraft HG, Duba HC, Kemmler HG, Seitz C.  Lp(a) glycoprotein phenotypes: inheritance and relation to Lp(a)-lipoprotein concentrations in plasma. J Clin Invest . 1987;;80:458-465.
11 +
McLean JW, Tomlinson JE, Kuang WJ, et al.  cDNA sequence of human apolipoprotein(a) is homologous to plasminogen. Nature . 1987;;330:132-137.
12 +
Lackner C, Boerwinkle E, Leffert CC, Rahmig T, Hobbs HH.  Molecular basis of apolipoprotein (a) isoform size heterogeneity as revealed by pulsed-field gel electrophoresis. J Clin Invest . 1991;;87:2153-2161.
13 +
Rath M, Niendorf A, Reblin T, Dietel M, Krebber HJ, Beisiegel U.  Detection and quantification of lipoprotein(a) in the arterial wall of 107 coronary bypass patients. Arteriosclerosis . 1989;;9:579-592.
14 +
Cushing GL, Gaubatz JW, Nava ML, et al.  Quantitation and localization of apolipoproteins (a) and B in coronary artery bypass vein grafts resected at re-operation. Arteriosclerosis . 1989;;9:593-603.
15 +
Nachman RL, Gavish D, Azrolan N, Clarkson TB.  Lipoprotein (a) in diet-induced atherosclerosis in nonhuman primates. Arteriosclerosis Thromb . 1991;;11:32-38.
16 +
Loscalzo J.  Lipoprotein(a): a unique risk factor for atherothrombotic disease. Arteriosclerosis . 1990;; 10:672-679.
17 +
Miles LA, Plow EF.  Lp(a): an interloper in the fibrinolytic system. Thromb Haemost . 1990;;63:331-335.
18 +
Rader DJ, Cain W, Zech LA, Kindt M, Usher D, Brewer HB Jr.  Lp(a): plasma levels in individuals with the same apo(a) isoprotein are determined by differences in production rates. Circulation . 1991;;84:565.
19 +
Utermann G, Hoppichler F, Dieplinger H, Seed M, Thompson G, Boerwinkle E.  Defects in the low density lipoprotein receptor gene affect lipoprotein (a) levels: multiplicative interaction of two gene lociassociated with premature atherosclerosis. Proc Natl Acad Sci U S A . 1989;;86:4171-4174.
20 +
Soutar AK, McCarthy SN, Seed M, Knight BL.  Relationship between apolipoprotein(a) phenotype, lipoprotein(a) concentration in plasma, and low density lipoprotein receptor function in a large kindred with familial hypercholesterolemia due to the pro664 to leu mutation in the LDL receptor gene. J Clin Invest . 1991;;88:483-492.
21 +
Seed M, Hoppichler F, Reaveley D, et al.  Relation of serum lipoprotein(a) concentration and apolipoprotein(a) phenotype to coronary heart disease in patients with familial hypercholesterolemia. N Engl J Med . 1990;;322:1494-1499.
22 +
Mann WA, Kraft HG, Rader DJ, et al.  Human in vivo catabolism of lipoprotein(a). Circulation . 1989;;80:II-181.
23 +
Hofmann SL, Eaton DL, Brown MS, McConathy WJ, Goldstein JL, Hammer RE.  Overexpression of human low density lipoprotein receptors leads to accelerated catabolism of Lp(a) lipoprotein in transgenic mice. J Clin Invest . 1990;;85:1542-1547.
24 +
Parra HJ, Mezdour H, Cachera C, Dracon M, Tacquet A, Fruchart JC.  Lp(a) lipoprotein in patients with chronic renal failure treated by hemodialysis. Clin Chem . 1987;;33:721.
25 +
Jenkins AJ, Steele JS, Janus ED, Best JD.  Increased plasma apolipoprotein(a) levels in IDDM patients with microalbuminuria. Diabetes . 1991;;40:787-790.
26 +
Sandkamp M, Assmann G.  Lipoprotein(a) in PROCAM participants and young myocardial infarction survivors.  In: Scanu AM, ed. Lipoprotein(a) . New York, NY: Academic Press; 1990;:205-209.
27 +
Meilahn EN, Kuller LH, Matthews KA, Stein EA.  Lp(a) concentrations among pre- and post-menopausal women over time: the Healthy Women Study. Circulation . 1991;;84:546.
28 +
Kervinen K, Savolainen MJ, Kesaniemi YA.  A rapid increase in lipoprotein (a) levels after ethanol withdrawal in alcoholic men. Life Sci . 1991;;48:2183-2188.
29 +
Albers JJ, Marcovina SM, Lodge MS.  The unique lipoprotein(a): properties and immunochemical measurement. Clin Chem . 1990;;36:2019-2026.
30 +
Hellsten G, Boman K, Hallmans G, Dahlen G.  Lipids and endurance physical activity. Atherosclerosis . 1989;;75:93-94.
31 +
Brewer HB Jr.  Effectiveness of diet and drugs in the treatment of patients with elevated Lp(a) levels.  In: Scanu AM, ed. Lipoprotein(a) . New York, NY: Academic Press; 1990;:211-220.
32 +
Kostner GM.  The physiological role of Lp(a).  In: Scanu AM, ed. Lipoprotein(a) . New York, NY: Academic Press; 1990;:183-204.
33 +
Carlson LA, Hamsten A, Asplund A.  Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid. J Intern Med . 1989;;226:271-276.
34 +
Gurakar A, Hoeg JM, Kostner G, Papadopoulos NM, Brewer HB Jr.  Levels of lipoprotein Lp(a) decline with neomycin and niacin treatment. Atherosclerosis . 1985;;57:293-301.
35 +
Brown G, Albers JJ, Fisher SM, et al.  Regression of coronary artery disease as a result of intensive lipid-lowering therapy in men with high levels of apolipoprotein B. N Engl J Med . 1990;;323:1289-1298.
36 +
Hoeg JM, Gregg RE, Brewer HB Jr.  An approach to the management of hyperlipoproteinemia. JAMA . 1986;;255:512-521.
37 +
Soma M, Fumagalli R, Paoletti R, et al.  Plasma Lp(a) concentration after oestrogen and progestagen in postmenopausal women. Lancet . 1991;;337:612. Letter.
38 +
Mosca L, Bowlin S, Davidson L, Jenkins P, Pearson TA.  Estrogen replacement therapy and lipoprotein (a). Circulation . 1991;;84:546.

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