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Novel Risk Factors for Atherosclerosis—Reply
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In Reply: In response to Dr von Eckardstein, in the study he cites,1 a serum Lp(a) level of 0.2 g/L or greater was associated with an increased risk of incident nonfatal myocardial infarction, fatal myocardial infarction, or sudden-death cardiovascular disease in patients with an already high predicted risk of cardiovascular disease using conventional risk factors. In this nested case-control study, in which there were 44 incident cardiovascular events, an elevated Lp(a) level did not add predictive value among patients within the first 3 quintiles of predicted global risk, and in the highest quintile the increase in risk of elevated Lp(a) level was of marginal statistical significance (relative risk, 2.8; 95% confidence interval, 1.1-7.2; P = .03). Therefore, while their analysis was suggestive of additive predictive value of elevated Lp(a) level to global risk scores, this study had relatively low statistical power to study this relationship rigorously. Moreover, surprising findings such . . . [Full Text of this Article]
Daniel G. Hackam, MD;
Sonia S. Anand, MD, PhD, FRCP
Department of Medicine
Faculty of Health Sciences
McMaster University
Hamilton, Ontario
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