Bennet A et al. (2008) Lipoprotein(a) levels and risk of future coronary heart disease: large-scale prospective data. Arch Intern Med 168: 598–608

Previous studies have indicated an association between circulating lipoprotein(a) levels and coronary heart disease (CHD). Now, Bennet et al. have conducted a large-scale study to assess the nature of this link and how it is affected by established cardiovascular risk factors. They conclude that lipoprotein(a) levels have an independent and almost continuous association with CHD and could prove a useful biomarker for risk of future CHD.

The authors screened a prospectively registered cohort of 18,569 individuals included in the Reykjavik study who had no history of myo-cardial infarction. Within the subgroup of patients with baseline lipoprotein(a) measurements, individuals who had experienced a first-ever nonfatal myocardial infarction or CHD-related death during follow-up were each paired for analysis with one or two matched controls who did not develop CHD.

Logarithmically transformed baseline lipoprotein(a) levels were higher in patients who developed CHD (n = 2,047) than in controls (n = 3,921) and changed little after approximately 12 years in the 372 patients for whom a second measurement was available. Log baseline lipoprotein(a) levels and established and emerging cardiovascular risk factors (e.g. albumin levels and blood pressure) did not correlate. Individuals with baseline lipoprotein(a) levels in the top third of the recorded values were more likely to develop CHD than were individuals in the bottom third (odds ratio after adjustment for age, sex and calendar year of recruitment 1.60, 95% CI 1.38–1.85). Odds ratios for CHD increased continuously with increasing fifths of baseline lipoprotein(a) level.