This Article  • Full text  • PDF  • Send to a friend  • Save in My Folder  • Save to citation manager  • Permissions  Citing Articles  • Contact me when this article is cited  Related Content  • Similar articles in JAMA  Topic Collections  • Cardiovascular Disease/ Myocardial Infarction  • Alert me on articles by topic

	Since this article does not have an abstract, we have provided the first 119 words of the full text and any section headings.

To the Editor: In their review article, Drs Hackam and Anand¹ discussed the 4 novel risk factors of C-reactive protein, lipoprotein(a) [Lp(a)], fibrinogen, and homocysteine to predict atherosclerosis. The authors concluded that their optimal use remains to be determined.

Because of the high negative predictive value of classic risk factors^2-3 there appears to be no need to screen for these novel risk factors as primary prevention. However, there is a need to improve risk estimation in groups of individuals with high and intermediate risk.⁴ In contrast to the conclusions of Hackam and Anand, we have reported that an Lp(a) level greater than 30 mg/dL (1.07 µmol/L) further increases the risk of men at intermediate and high estimated global risk.⁵

Arnold von Eckardstein, MD
Institute of Clinical Chemistry
University Hospital Zurich
Zurich, Switzerland

1. Hackam DG, Anand SS. Emerging risk factors for atherosclerotic vascular disease: a critical review of the evidence. JAMA. 2003;290:932-940. FREE FULL TEXT 2. Khot UN, Khot MB, Bajzer CT, et al. Prevalence of conventional risk factors in patients with coronary heart disease. JAMA. 2003;290:898-904. FREE FULL TEXT 3. Greenland P, Knoll MD, Stamler J, et al. Major risk factors as antecedents of fatal and nonfatal coronary heart disease events. JAMA. 2003;290:891-897. FREE FULL TEXT 4. von Eckardstein A. Is there a need for novel cardiovascular risk factors? Nephrol Dial Transplant. In press. 5. von Eckardstein A, Schulte H, Cullen P, Assmann G. Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk. J Am Coll Cardiol. 2001;37:434-439. FREE FULL TEXT

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291:301.