Lipoprotein(a) Levels and Risk of Future Coronary Heart DiseaseLarge-Scale Prospective Data

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Abstract
Lipoprotein(a) (Lp[a]) is a low-density lipoprotein–like particle synthesized by the liver that consists of an apolipoprotein B molecule covalently linked to a very large glycoprotein known as apolipoprotein(a) (Apo[a]).1,2 Several epidemiologic studies have assessed the association between circulating Lp(a) levels and cardiovascular diseases. By 2000, there were 18 population-based prospective studies3-20 that had reported on Lp(a) levels and coronary heart disease (CHD) risk, with most, but not all, reporting positive associations. Few studies, however, have been adequately powered to examine potentially important aspects of the association, such as the shape of the Lp(a)-CHD relationship and the size of relative risks in clinically relevant subgroups (such as in men and women or at different levels of established risk factors). A previous review21 suggested a moderately strong overall association between Lp(a) levels and CHD risk, but because it analyzed only published data (rather than primary data) it did not address the uncertainties described in the preceding sentences. Furthermore, data on within-person variability are needed to help assess the long-term relevance of Lp(a) to CHD, but only 1 previous study22 has reported on it using a small subset of individuals.