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Novel Risk Factors for AtherosclerosisNovel Risk Factors for Atherosclerosis

JAMA. 2004;291(3):301-301. doi:10.1001/jama.291.3.301-a
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AUTHOR INFORMATION

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

NOVEL RISK FACTORS FOR ATHEROSCLEROSIS

To the Editor: In their review article, Drs Hackam and Anand1 discussed the 4 novel risk factors of C-reactive protein, lipoprotein(a) [Lp(a)], fibrinogen, and homocysteine to predict atherosclerosis. The authors concluded that their optimal use remains to be determined.

Because of the high negative predictive value of classic risk factors2 3 there appears to be no need to screen for these novel risk factors as primary prevention. However, there is a need to improve risk estimation in groups of individuals with high and intermediate risk.4 In contrast to the conclusions of Hackam and Anand, we have reported that an Lp(a) level greater than 30 mg/dL (1.07 µmol/L) further increases the risk of men at intermediate and high estimated global risk.5

References
Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence.  JAMA.2003;290:932-940.
PubMed
Khot UN, Khot MB, Bajzer CT.  et al.  Prevalence of conventional risk factors in patients with coronary heart disease.  JAMA.2003;290:898-904.
PubMed
Greenland P, Knoll MD, Stamler J.  et al.  Major risk factors as antecedents of fatal and nonfatal coronary heart disease events.  JAMA.2003;290:891-897.
PubMed
von Eckardstein A. Is there a need for novel cardiovascular risk factors?  Nephrol Dial Transplant.In press.
von Eckardstein A, Schulte H, Cullen P, Assmann G. Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk.  J Am Coll Cardiol.2001;37:434-439.
PubMed

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Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence.  JAMA.2003;290:932-940.
PubMed
Khot UN, Khot MB, Bajzer CT.  et al.  Prevalence of conventional risk factors in patients with coronary heart disease.  JAMA.2003;290:898-904.
PubMed
Greenland P, Knoll MD, Stamler J.  et al.  Major risk factors as antecedents of fatal and nonfatal coronary heart disease events.  JAMA.2003;290:891-897.
PubMed
von Eckardstein A. Is there a need for novel cardiovascular risk factors?  Nephrol Dial Transplant.In press.
von Eckardstein A, Schulte H, Cullen P, Assmann G. Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk.  J Am Coll Cardiol.2001;37:434-439.
PubMed
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To understand the clinical management of acute heart failure syndromes.
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