This Article  • References  • Full text PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Citation map  • Citing articles on HighWire  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Social Bookmarking   What's this?

Paul M. Ridker, MD; Charles H. Hennekens, MD; Meir J. Stampfer, MD

JAMA. 1993;270(18):2195-2199.

Abstract
Objective.
—To assess prospectively the risk of myocardial infarction (Ml) associated with elevated levels of lipoprotein(a) (Lp[a]).

Design.
—Nested case-control study using prospectively collected plasma samples.

Setting.
—Participants in the Physicians' Health Study.

Participants.
—A total of 14916 male physicians aged 40 to 84 years with no prior history of Ml or stroke provided plasma samples at baseline and were followed up prospectively for an average period of 60.2 months. Samples from 296 physicians who subsequently developed Ml were analyzed for Lp(a) level together with paired controls, matched for smoking status and age.

Main Outcome Measure.
—Fatal or nonfatal acute Ml.

Results.
—The distribution of Lp(a) level among cases was virtually identical to that of controls (P=.88), and there was no significant difference between groups for median Lp(a) levels (103.0 mg/L vs 102.5 mg/L; P=.73). In analyses controlling for age and smoking status, we found no evidence of association between increasing level of Lp(a) and risk of Ml (relative risks from lowest to highest quintiles of Lp(a): 1.00, 0.97, 0.83, 0.88, and 1.07; P for trend=.93) or a threshold effect at any prespecified cutoff of Lp(a) level (relative risks associated with Lp[a] levels above the 25th, 50th, 75th, 90th, and 95th percentiles of the control distribution, respectively: 1.04,1.00,1.19,1.00, and 1.07; all Pvalues nonsignificant). Further adjustment for both lipid and nonlipid cardiovascular risk factors had no material impact.

Conclusions.
—In this prospective study of predominantly middle-aged white men, we found no evidence of association between Lp(a) level and risk of future Ml. These data do not support the use of Lp(a) level as a screening tool to define cardiovascular risk among this population.

(JAMA. 1993;270:2195-2199)

Author Affiliations
From the Divisions of Preventive Medicine (Drs Ridker and Hennekens) and Cardiology (Dr Ridker), and the Channing Laboratory (Dr Stampfer), Department of Medicine, Brigham and Women's Hospital, and the Department of Ambulatory Care and Prevention (Dr Hennekens), Harvard Medical School and the Department of Epidemiology (Dr Stampfer), Harvard School of Public Health, Boston, Mass.

Footnotes
Reprint requests to Brigham and Women's Hospital, 900 Commonwealth Ave E, Boston, MA 02215-1204 (Dr Ridker).

CiteULike    Connotea    Del.icio.us    Digg    Reddit    Technorati    Twitter     What's this?

THIS ARTICLE HAS BEEN CITED BY OTHER ARTICLES

Emerging Risk Factors for Coronary Heart Disease: A Summary of Systematic Reviews Conducted for the U.S. Preventive Services Task Force
Helfand et al.
ANN INTERN MED 2009;151:496-507.
ABSTRACT | FULL TEXT  

Lipoprotein(a) Concentration and the Risk of Coronary Heart Disease, Stroke, and Nonvascular Mortality
The Emerging Risk Factors Collaboration
JAMA 2009;302:412-423.
ABSTRACT | FULL TEXT  

Determination of lipoprotein(a) kringle repeat number from genomic DNA: copy number variation genotyping using qPCR
Lanktree et al.
J. Lipid Res. 2009;50:768-772.
ABSTRACT | FULL TEXT  

Lipoprotein(a) Levels and Risk of Future Coronary Heart Disease: Large-Scale Prospective Data
Bennet et al.
Arch Intern Med 2008;168:598-608.
ABSTRACT | FULL TEXT  

Plasma Lipoprotein(a) Indicates Risk for 4 Distinct Forms of Vascular Disease
Jones et al.
Clin. Chem. 2007;53:679-685.
ABSTRACT | FULL TEXT  

Dyslipidaemia and global cardiovascular risk: clinical issues
Assmann
Eur Heart J Suppl 2006;8:F40-F46.
ABSTRACT | FULL TEXT  

Lipoprotein(a), measured with an assay independent of apolipoprotein(a) isoform size, and risk of future cardiovascular events among initially healthy women.
Suk Danik et al.
JAMA 2006;296:1363-1370.
ABSTRACT | FULL TEXT  

Relation Between Lipoprotein(a) and Fibrinogen and Serial Intravascular Ultrasound Plaque Progression in Left Main Coronary Arteries
Hartmann et al.
J Am Coll Cardiol 2006;48:446-452.
ABSTRACT | FULL TEXT  

C-reactive protein and other emerging blood biomarkers to optimize risk stratification of vulnerable patients.
Tsimikas et al.
J Am Coll Cardiol 2006;47:C19-C31.
ABSTRACT | FULL TEXT  

An Apolipoprotein(a) Peptide Delays Chylomicron Remnant Clearance and Increases Plasma Remnant Lipoproteins and Atherosclerosis In Vivo
Devlin et al.
Arterioscler. Thromb. Vasc. Bio. 2005;25:1704-1710.
ABSTRACT | FULL TEXT  

Conditional Risk Factors for Atherosclerosis
Kullo and Ballantyne
Mayo Clin Proc. 2005;80:219-230.
ABSTRACT  

Apolipoprotein(a) Size and Lipoprotein(a) Concentration and Future Risk of Angina Pectoris with Evidence of Severe Coronary Atherosclerosis in Men: The Physicians' Health Study
Rifai et al.
Clin. Chem. 2004;50:1364-1371.
ABSTRACT | FULL TEXT  

High lipoprotein(a) levels and small apolipoprotein(a) sizes are associated with endothelial dysfunction in a multiethnic cohort
Wu et al.
J Am Coll Cardiol 2004;43:1828-1833.
ABSTRACT | FULL TEXT  

Lipoprotein(a) Is an Independent Risk Factor for Peripheral Arterial Disease in Chinese Type 2 Diabetic Patients in Taiwan
Tseng
Diabetes Care 2004;27:517-521.
ABSTRACT | FULL TEXT  

Lp(a) Lipoprotein, Vascular Disease, and Mortality in the Elderly
Ariyo et al.
NEJM 2003;349:2108-2115.
ABSTRACT | FULL TEXT  

Emerging Risk Factors for Atherosclerotic Vascular Disease: A Critical Review of the Evidence
Hackam and Anand
JAMA 2003;290:932-940.
ABSTRACT | FULL TEXT  

Association of Polymorphisms of the Apolipoprotein(a) Gene With Lipoprotein(a) Levels and Myocardial Infarction
Holmer et al.
Circulation 2003;107:696-701.
ABSTRACT | FULL TEXT  

Lipoprotein(a) Enhances Advanced Atherosclerosis and Vascular Calcification in WHHL Transgenic Rabbits Expressing Human Apolipoprotein(a)
Sun et al.
J. Biol. Chem. 2002;277:47486-47492.
ABSTRACT | FULL TEXT  

Elevated Serum Lipoprotein(a) Level Is an Independent Marker of Severity of Thoracic Aortic Atherosclerosis*
Peltier et al.
Chest 2002;121:1589-1594.
ABSTRACT | FULL TEXT  

Lipoprotein(a) Promotes Smooth Muscle Cell Proliferation and Dedifferentiation in Atherosclerotic Lesions of Human Apo(a) Transgenic Rabbits
Ichikawa et al.
Am. J. Pathol. 2002;160:227-236.
ABSTRACT | FULL TEXT  

Instability of Lipoprotein(a) in Plasma Stored at -70 {degrees}C : Effects of Concentration, Apolipoprotein(a) Genotype, and Donor Cardiovascular Disease
Simo et al.
Clin. Chem. 2001;47:1673-1678.
ABSTRACT | FULL TEXT  

Lipoprotein(a) and Cognitive Performances in an Elderly White Population : Cross-Sectional and Follow-Up Data
Sarti et al.
Stroke 2001;32:1678-1683.
ABSTRACT | FULL TEXT  

Lipoprotein(a) changes during natural menstrual cycle and ovarian stimulation with recombinant and highly purified urinary FSH
Ricci et al.
Hum Reprod 2001;16:449-456.
ABSTRACT | FULL TEXT  

Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk
von Eckardstein et al.
J Am Coll Cardiol 2001;37:434-439.
ABSTRACT | FULL TEXT  

Transgenic Rabbits Expressing Human Apolipoprotein(a) Develop More Extensive Atherosclerotic Lesions in Response to a Cholesterol-Rich Diet
Fan et al.
Arterioscler. Thromb. Vasc. Bio. 2001;21:88-94.
ABSTRACT | FULL TEXT  

High Levels of Lp(a) With a Small Apo(a) Isoform Are Associated With Coronary Artery Disease in African American and White Men
Paultre et al.
Arterioscler. Thromb. Vasc. Bio. 2000;20:2619-2624.
ABSTRACT | FULL TEXT  

Lipoprotein(a) and Coronary Heart Disease : Meta-Analysis of Prospective Studies
Danesh et al.
Circulation 2000;102:1082-1085.
ABSTRACT | FULL TEXT  

Effects of Growth Hormone Administration on Inflammatory and Other Cardiovascular Risk Markers in Men with Growth Hormone Deficiency: A Randomized, Controlled Clinical Trial
Sesmilo et al.
ANN INTERN MED 2000;133:111-122.
ABSTRACT | FULL TEXT  

Defects of the LDL receptor in WHHL transgenic rabbits lead to a marked accumulation of plasma lipoprotein[a]
Fan et al.
J. Lipid Res. 2000;41:1004-1012.
ABSTRACT | FULL TEXT  

Estrogen and Progestin, Lipoprotein(a), and the Risk of Recurrent Coronary Heart Disease Events After Menopause
Shlipak et al.
JAMA 2000;283:1845-1852.
ABSTRACT | FULL TEXT  

Lipoprotein(a) is a risk factor for occurrence of acute myocardial infarction in patients with coronary vasospasm
Miwa et al.
J Am Coll Cardiol 2000;35:1200-1205.
ABSTRACT | FULL TEXT  

Lack of association of lipoprotein(a) levels with coronary calcium deposits in asymptomatic postmenopausal women
Nishino et al.
J Am Coll Cardiol 2000;35:314-320.
ABSTRACT | FULL TEXT  

Lipoprotein(a): from ancestral benefit to modern pathogen?
Lippi and Guidi
QJM 2000;93:75-84.
ABSTRACT | FULL TEXT  

Homocysteine and Lipoprotein(a) Interact to Increase CAD Risk in Young Men and Women
Foody et al.
Arterioscler. Thromb. Vasc. Bio. 2000;20:493-499.
ABSTRACT | FULL TEXT  

Assessment of cardiovascular risk by use of multiple-risk-factor assessment equations: A statement for healthcare professionals from the American Heart Association and the American College of Cardiology
Grundy et al.
J Am Coll Cardiol 1999;34:1348-1359.
FULL TEXT  

Assessment of Cardiovascular Risk by Use of Multiple-Risk-Factor Assessment Equations : A Statement for Healthcare Professionals From the American Heart Association and the American College of Cardiology
Grundy et al.
Circulation 1999;100:1481-1492.
FULL TEXT  

Potential New Cardiovascular Risk Factors: Left Ventricular Hypertrophy, Homocysteine, Lipoprotein(a), Triglycerides, Oxidative Stress, and Fibrinogen
Harjai
ANN INTERN MED 1999;131:376-386.
ABSTRACT | FULL TEXT  

Cross-Sectional Study of Soluble Intercellular Adhesion Molecule-1 and Cardiovascular Risk Factors in Apparently Healthy Men
Rohde et al.
Arterioscler. Thromb. Vasc. Bio. 1999;19:1595-1599.
ABSTRACT | FULL TEXT  

Plasma Concentrations of Interleukin-6 and Abdominal Aortic Diameter Among Subjects Without Aortic Dilatation
Rohde et al.
Arterioscler. Thromb. Vasc. Bio. 1999;19:1695-1699.
ABSTRACT | FULL TEXT  

Lipoprotein(a)-Cholesterol and Coronary Heart Disease in the Framingham Heart Study
Seman et al.
Clin. Chem. 1999;45:1039-1046.
ABSTRACT | FULL TEXT  

Evaluating Novel Cardiovascular Risk Factors: Can We Better Predict Heart Attacks?
Ridker
ANN INTERN MED 1999;130:933-937.
ABSTRACT | FULL TEXT  

Estrogen Modulation of Apolipoprotein(a) Expression. IDENTIFICATION OF A REGULATORY ELEMENT
Boffelli et al.
J. Biol. Chem. 1999;274:15569-15574.
ABSTRACT | FULL TEXT  

Lipoprotein(a) and coronary thrombosis and restenosis after stent placement
Wehinger et al.
J Am Coll Cardiol 1999;33:1005-1012.
ABSTRACT | FULL TEXT  

Lipoprotein(a) and dietary proteins: casein lowers lipoprotein(a) concentrations as compared with soy protein
Nilausen and Meinertz
Am. J. Clin. Nutr. 1999;69:419-425.
ABSTRACT | FULL TEXT  

Lipid and Apolipoprotein Predictors of Atherosclerosis in Youth : Apolipoprotein Concentrations Do Not Materially Improve Prediction of Arterial Lesions in PDAY Subjects
Rainwater et al.
Arterioscler. Thromb. Vasc. Bio. 1999;19:753-761.
ABSTRACT | FULL TEXT  

Circulating Cell Adhesion Molecules Are Correlated With Ultrasound-Based Assessment of Carotid Atherosclerosis
Rohde et al.
Arterioscler. Thromb. Vasc. Bio. 1998;18:1765-1770.
ABSTRACT | FULL TEXT  

Lipoprotein(a) as a risk factor for ischemic heart disease: metaanalysis of prospective studies
Craig et al.
Clin. Chem. 1998;44:2301-2306.
ABSTRACT | FULL TEXT  

Maximizing the Cost-effectiveness of Lipid-Lowering Therapy
Jacobson et al.
Arch Intern Med 1998;158:1977-1989.
ABSTRACT | FULL TEXT  

Metabolism of Apo(a) and ApoB100 of Lipoprotein(a) in Women: Effect of Postmenopausal Estrogen Replacement
Su et al.
J. Clin. Endocrinol. Metab. 1998;83:3267-3276.
ABSTRACT | FULL TEXT  

Evolving lipoprotein risk factors: lipoprotein(a) and oxidized low-density lipoprotein
Jialal
Clin. Chem. 1998;44:1827-1832.
ABSTRACT | FULL TEXT  

Primary Prevention of Coronary Heart Disease: Guidance From Framingham : A Statement for Healthcare Professionals From the AHA Task Force on Risk Reduction
Grundy et al.
Circulation 1998;97:1876-1887.
FULL TEXT  

Effects of Reducing Dietary Saturated Fatty Acids on Plasma Lipids and Lipoproteins in Healthy Subjects : The Delta Study, Protocol 1
Ginsberg et al.
Arterioscler. Thromb. Vasc. Bio. 1998;18:441-449.
ABSTRACT | FULL TEXT  

Lipoprotein(a) Interactions With Lipid and Nonlipid Risk Factors in Early Familial Coronary Artery Disease
Hopkins et al.
Arterioscler. Thromb. Vasc. Bio. 1997;17:2783-2792.
ABSTRACT | FULL TEXT  

Predictive Value of Electrophoretically Detected Lipoprotein(a) for Coronary Heart Disease and Cerebrovascular Disease in a Community-Based Cohort of 9936 Men and Women
Nguyen et al.
Circulation 1997;96:1390-1397.
ABSTRACT | FULL TEXT  

Genetic Variation in Factor VII Associated with Variation in Plasma Lipoprotein(a) Concentration
Hegele et al.
Arterioscler. Thromb. Vasc. Bio. 1997;17:1701-1706.
ABSTRACT | FULL TEXT  

Hormonal Regulation of Lipoprotein(a) Levels: Effects of Estrogen Replacement Therapy on Lipoprotein(a) and Acute Phase Reactants in Postmenopausal Women
Tuck et al.
Arterioscler. Thromb. Vasc. Bio. 1997;17:1822-1829.
ABSTRACT | FULL TEXT  

Lipoprotein Lp(a) Excess and Coronary Heart Disease
Stein and Rosenson
Arch Intern Med 1997;157:1170-1176.
ABSTRACT  

Association of Serum Lipoprotein(a) Levels and Apolipoprotein(a) Size Polymorphism With Target-Organ Damage in Arterial Hypertension
Sechi et al.
JAMA 1997;277:1689-1695.
ABSTRACT  

Inflammation, Aspirin, and the Risk of Cardiovascular Disease in Apparently Healthy Men
Ridker et al.
NEJM 1997;336:973-979.
ABSTRACT | FULL TEXT  

A Prospective Case-Control Study of Lipoprotein(a) Levels and Apo(a) Size and Risk of Coronary Heart Disease in Stanford Five-City Project Participants
Wild et al.
Arterioscler. Thromb. Vasc. Bio. 1997;17:239-245.
ABSTRACT | FULL TEXT  

Lipoprotein(a) as a Determinant of Coronary Heart Disease in Young Women
Orth-Gomer et al.
Circulation 1997;95:329-334.
ABSTRACT | FULL TEXT  

Elevated Lipoprotein(a) and Premature Coronary Heart Disease
Maher and Brown
JAMA 1997;277:209-209.
ABSTRACT  

Lipoprotein(a) in Stored Plasma Samples and the Ravages of Time: Why Epidemiological Studies Might Fail
Kronenberg et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:1568-1572.
ABSTRACT | FULL TEXT  

Serum Lipoprotein(a) Level Is Related to Thrombin Generation and Spontaneous Intermittent Coronary Occlusion in Patients With Acute Myocardial Infarction
Haider et al.
Circulation 1996;94:2072-2076.
ABSTRACT | FULL TEXT  

Elevated Plasma Lipoprotein(a) and Coronary Heart Disease in Men Aged 55 Years and Younger: A Prospective Study
Bostom et al.
JAMA 1996;276:544-548.
ABSTRACT  

Lipoprotein(a) in Patients With Acute Cerebral Ischemia
van Kooten et al.
Stroke 1996;27:1231-1235.
ABSTRACT | FULL TEXT  

Apolipoprotein(a) Kringle IV Repeat Number Predicts Risk for Coronary Heart Disease
Kraft et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:713-719.
ABSTRACT | FULL TEXT  

Cardiovascular Effects of Estrogen and Lipid-Lowering Therapies in Postmenopausal Women
Guetta and Cannon
Circulation 1996;93:1928-1937.
FULL TEXT  

Race and Gender Differences in the Association of Lp(a) With Carotid Artery Wall Thickness : The Atherosclerosis Risk in Communities (ARIC) Study
Schreiner et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:471-478.
ABSTRACT | FULL TEXT  

Plasma Lipoprotein(a) Levels in Subjects Attending a Metabolic Ward : Discrimination Between Individuals With and Without a History of IschemicStroke
Margaglione et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:120-128.
ABSTRACT | FULL TEXT  

Lp(a) Levels and Atherosclerotic Vascular Disease in a Sample of Patients With Familial Hypercholesterolemia Sharing the Same Gene Defect
Carmena et al.
Arterioscler. Thromb. Vasc. Bio. 1996;16:129-136.
ABSTRACT | FULL TEXT  

Effects of Lowering Elevated LDL Cholesterol on the Cardiovascular Risk of Lipoprotein(a)
Maher et al.
JAMA 1995;274:1771-1774.
ABSTRACT  

Lipoprotein(a) Concentration and Risk of Atherothrombotic Disease-Reply
Ridker et al.
JAMA 1995;274:1198-1199.
ABSTRACT  

Inhibitors for the In Vitro Assembly of Lp(a)
Frank et al.
Arterioscler. Thromb. Vasc. Bio. 1995;15:1774-1780.
ABSTRACT | FULL TEXT  

Apo(a) Phenotypes and Lp(a) Concentrations in Offspring of Men With and Without Myocardial Infarction : The EARS Study
Klausen et al.
Arterioscler. Thromb. Vasc. Bio. 1995;15:1001-1008.
ABSTRACT | FULL TEXT  

Dose-Response Relationships of Serum Lipid Measurements With the Extent of Coronary Stenosis : Strong, Independent, and Comprehensive
Bolibar et al.
Arterioscler. Thromb. Vasc. Bio. 1995;15:1035-1042.
ABSTRACT | FULL TEXT  

Coronary Artery Disease in Heterozygous Familial Hypercholesterolemia Patients With the Same LDL Receptor Gene Mutation
Ferrieres et al.
Circulation 1995;92:290-295.
ABSTRACT | FULL TEXT  

No Association Between Plasma Lipoprotein(a) Concentrations and the Presence or Absence of Coronary Atherosclerosis in African-Americans
Moliterno et al.
Arterioscler. Thromb. Vasc. Bio. 1995;15:850-855.
ABSTRACT | FULL TEXT  

Plasma Concentration of Lipoprotein(a) and the Risk of Future Stroke
Ridker et al.
JAMA 1995;273:1269-1273.
ABSTRACT  

Identification of Two Functionally Distinct Lysine-binding Sites in Kringle 37 and in Kringles 32-36 of Human Apolipoprotein(a)
Ernst et al.
J. Biol. Chem. 1995;270:6227-6234.
ABSTRACT | FULL TEXT  

Angiotensin-Converting Enzyme and Lipoprotein(a) as Risk Factors for Myocardial Infarction
Haber
Circulation 1995;91:1888-1890.
FULL TEXT  

Lipid and Lipoprotein Factors Associated With Variation in Lp(a) Density
Rainwater et al.
Arterioscler. Thromb. Vasc. Bio. 1995;15:313-319.
ABSTRACT | FULL TEXT  

Association of Fibrinolytic Parameters With Early Atherosclerosis : The ARIC Study
Salomaa et al.
Circulation 1995;91:284-290.
ABSTRACT | FULL TEXT  

Genetic Basis of Lipoprotein Disorders
Dammerman and Breslow
Circulation 1995;91:505-512.
FULL TEXT  

Comparative Effects of Lovastatin and Niacin in Primary Hypercholesterolemia: A Prospective Trial
Illingworth et al.
Arch Intern Med 1994;154:1586-1595.
ABSTRACT  

Lipoprotein(a) and Risk of Myocardial Infarction
Gaw
JAMA 1994;271:1077-1077.
ABSTRACT  

Lipoprotein(a) and Risk of Myocardial Infarction
Ritter et al.
JAMA 1994;271:1077-1077.
ABSTRACT  

Lipoprotein(a) Levels and Risk of Coronary Heart Disease in Men: The Lipid Research Clinics Coronary Primary Prevention Trial
Schaefer et al.
JAMA 1994;271:999-1003.
ABSTRACT  

Lipoprotein(a) in Coronary Heart Disease: Is It a Risk Factor After All?
Gurewich and Mittleman
JAMA 1994;271:1025-1026.
ABSTRACT  

LIPOPROTEIN(A) LOSES CREDIBILITY AS AN MI PREDICTOR
JWatch General 1993;1993:6-6.
FULL TEXT  

Has Lipoprotein 'Little' (a) Shrunk?
Barnathan
JAMA 1993;270:2224-2225.
ABSTRACT