Elevated Lipoprotein(a) and Premature Coronary Heart Disease

To the Editor. —Dr Bostom and colleagues in a prospective study¹report 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,¹previous 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,²and 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