What does this research mean for the field?

The previously established role of lipoprotein(a) as a risk factor for coronary heart disease is questionable, given multiple recent studies showing no significant association between Lp(a) levels and clinical CHD. Novelty: ClaimNovelty.SYNTHESIS. Consensus alignment: ConsensusAlignment.CHALLENGES_CONSENSUS.

April 6, 1994

Lipoprotein(a) in Coronary Heart Disease

Structured PICO

Is elevated lipoprotein(a) associated with an increased risk of coronary heart disease?

Population

Populations from multiple studies including hyperlipidemic men, men and women older than 60 years, and participants in the Physicians' Health Study

Intervention

Elevated Lipoprotein(a) [Lp(a)] levels

Comparator

Lower Lipoprotein(a) [Lp(a)] levels

Outcome

Coronary heart disease (CHD) eventshard clinical

This editorial highlights emerging evidence that questions the previously established association between elevated lipoprotein(a) and coronary heart disease risk.

Abstract

The role of lipoprotein(a) Lp(a) in coronary heart disease (CHD), once considered to be well established, has recently been put into question. For example, in a prospective, nested case-control study of the Helsinki Heart Study participants, Jauhiainen et al1found no significant increase in risk of CHD associated with higher levels of Lp(a) among 138 hyperlipidemic men who developed coronary events compared with 130 controls. A similar lack of association between Lp(a) and clinical CHD was reported by Simons et al2from a cross-sectional analysis of 1202 men and 1512 women older than 60 years. The skewed and broad distribution of Lp(a) levels, ranging from 1.0 mg/dL (0.03 mmol/L) to 210.0 mg/dL (5.25 mmol/L), was strikingly similar in the two groups. Finally, in a report published recently inThe JOURNALinvolving the prospective Physicians' Health Study, Ridker et al3found a "virtually identical" Lp(a) distribution among 296

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