Lipoprotein Lp(a) as predictor of myocardial infarction in comparison to fibrinogen, LDL cholesterol and other risk factors: results from the prospective Göttingen Risk Incidence and Prevalence Study (GRIPS)

Abstract

Based on pathophysiological findings Lp(a) is considered to be a cardiovascular risk factor. The Göttingen Risk Incidence and Prevalence Study (GRIPS) provides the possibility to evaluate this impact of Lp(a) on the basis of a large prospective cohort study. GRIPS included 6002 men, aged 40-59.9 years at baseline. Data of a 5 year follow-up period is now available for > 95% of the study participants. Multivariate logistic regression models for the estimation of MI risk confirm Lp(a) as an important risk factor, ranking fifth behind LDL cholesterol, family history of MI, plasma fibrinogen and HDL cholesterol (inversely related). The GRIPS data strongly support strategies for the identification and treatment of persons at increased MI risk which focus on LDL cholesterol. However, Lp(a) and fibrinogen have to be seriously considered as additional risk factors and should be included in diagnostic panels for the estimation of MI risk.

Blood viscosity and risk of cardiovascular events: the Edinburgh Artery Study

“…Lipoproteins also affect plasma and blood viscosity (Lowe et al, 1982;Lowe, 1994); however, in the present study LDL cholesterol did not appear a strong determinant of the predictive value of viscosity for cardiovascular events (or vice versa). Seven other studies have shown that plasma fibrinogen is a predictor of cardiovascular events (Wilhelmsen et al, 1984;Stone & Thorp, 1985;Meade et al, 1986;Kannel et al, 1987;Yarnell et al, 1991;Ernst & Resch, 1993;Cremer et al, 1994;Heinrich et al, 1994); the present study suggests that increased blood viscosity may be one mechanism by which hyperfibrinogenaemia (as well as raised haematocrit) may promote cardiovascular events. Finally, increased viscosity may be one explanation for international differences in cardiovascular risk (Koenig et al, 1994).…”

The effect of recombinant human GH replacement therapy on lipoprotein(a) and other lipid parameters in adults with acquired GH deficiency: results of a double-blind and placebo-controlled trial

“…Although conflicting conclusions about the association between Lp(a) and the risk of coronary heart disease have been drawn from prospective studies, these discrepancies may be due in part to differences in patient selection and study design. In the case of the Physicians Health Study (8) participants were on average 10 years older and had lower cholesterol levels than in the four other studies (7,(9)(10)(11). In this respect it must be noted that, in a crosssectional study of cardiovascular risk factors in men and women 60 years of age and older (46), Lp(a) was not associated with cardiovascular disease.…”

“…The results from prospective studies have been less clear-cut. While two reports found no association (7,8), a further three studies each reported Lp(a) to be an independent risk factor for coronary heart disease in hypercholesterolemic middle-aged white men (9)(10)(11).…”

Diterpenes from coffee beans decrease serum levels of lipoprotein(a) in humans: results from four randomised controlled trials

“…An extensive body of laboratory evidence indicates a critical role of Lp(a) in the development of atherothrombotic diseases (Marcovina & Morrisett, 1995), which is con®rmed by most (Rosengren et al, 1990;Sigurdsson et al, 1992;Wald et al, 1994;Cremer et al, 1994;Bostom et al, 1994;Schaefer et al, 1994;Terres et al, 1995;Bostom et al, 1996), though not all Ridker et al, 1993;Alfthan et al, 1994;Ridker et al, 1995), prospective cohort studies. The circulating level of Lp(a) is largely under genetic control (Boerwinkle et al, 1992), and is unaffected by many interventions known to affect LDL metabolism, including most dietary interventions (Berglund, 1995).…”