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ARTICLE |

Elevated Lipoprotein(a) and Premature Coronary Heart Disease FREE

Vincent M. G. Maher, MD, MRCPI; B. Greg Brown, MD, PhD
JAMA. 1997;277(3):209-209. doi:10.1001/jama.1997.03540270035011
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To the Editor.  —The article by Dr Bostom and colleagues1 reaffirms the importance of an elevated lipoprotein(a) [Lp(a)] level as a cardiac risk factor. We have postulated previously, based on our analysis of published works,2 that a pathological interaction exists between increased Lp(a) levels and elevated low-density lipoprotein (LDL) cholesterol levels, which is confirmed by our own experience.3 Furthermore, by lowering LDL cholesterol levels alone, the adverse effects of the interaction of these 2 particles is greatly diminished.3Bostom and colleagues did not observe such an interaction. The most likely explanation is that LDL cholesterol levels in their study were low (mean, 3.5 mmol/L [135 mg/dL]) relative to the mean LDL cholesterol levels in most studies previously published.2 We observed that, in the presence of such low LDL cholesterol levels, increased Lp(a) levels had only a small or negligible impact on disease outcome.2 In

REFERENCES

Bostom AG, Cupples A, Jenner JL, et al.  Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger: a prospective study . JAMA . 1996;;276:544-548.
Maher VMG, Brown BG.  Lipoprotein(a) and coronary heart disease . Curr Opin Lipidol . 1995;;6:229-235.
Maher VMG, Brown BG, Marcovina SM, Hillger LA, Zhao X-Q, Albers JJ.  Effects of lowering elevated LDL cholesterol on the cardiovascular risk of lipoprotein(a) . JAMA . 1995;;274:1771-1774.
Ridker PM, Hennekens CH, Stampfer MJ.  A prospective study of lipoprotein(a) and the risk of myocardial infarction . JAMA . 1993;;270:2195-2199.

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Bostom AG, Cupples A, Jenner JL, et al.  Elevated plasma lipoprotein(a) and coronary heart disease in men aged 55 years and younger: a prospective study . JAMA . 1996;;276:544-548.
Maher VMG, Brown BG.  Lipoprotein(a) and coronary heart disease . Curr Opin Lipidol . 1995;;6:229-235.
Maher VMG, Brown BG, Marcovina SM, Hillger LA, Zhao X-Q, Albers JJ.  Effects of lowering elevated LDL cholesterol on the cardiovascular risk of lipoprotein(a) . JAMA . 1995;;274:1771-1774.
Ridker PM, Hennekens CH, Stampfer MJ.  A prospective study of lipoprotein(a) and the risk of myocardial infarction . JAMA . 1993;;270:2195-2199.
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To understand the clinical management of acute heart failure syndromes.
Accreditation Information The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians.
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