Mon 27 Jul 2009
Usefulness of Lp(a) as a risk factor for cvd
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A recent study reported in the July 22/29, 2009 issue of the Journal of the American Medical Association has looked again at the significance of the blood lipoprotein Lp(a) as a risk factor for future cardiovascular disease. The authors pooled the results of 36 prospective studies and calculated the overall risks. The pooled analysis included records of over 126,000 patients.
The authors found that increasing Lp(a) levels in blood are continuously associated with an increasing risk of cardiovascular disease such as coronary artery disease and stroke. However the actual degree of risk is quite small compared to more traditional risk factors such as LDL cholesterol and blood pressure.
Niacin (nicotinic acid) is the only agent known to significantly lower Lp(a) levels. At the same time it also lowers LDL cholesterol and triglycerides and increases HDL cholesterol. Thus it is not known if the benefits derived from taking niacin are due even in part to lowering Lp(a).
Because the effects of lowering Lp(a) are unknown and because of its weak association with CVD risk, the authors think that there is currently little benefit in measuring Lp(a) levels in patients. This is only likely to change if newer drugs are developed that specifically cause large drops in Lp(a) levels and this is associated with a reduction in CVD risk that is independent of, or increases the benefits of LDL cholesterol lowering.