Prediction of cardiovascular diseas...

Prediction of cardiovascular disease among the somewhat old is complicated by the fact that traditional risk factors are not as meaningful in this age assign places to Basic research has indicated that Lp(a) lipoprotein is base in atherosclerotic plaques and plays a character in thrombotic complications at these plaque sites. Prospective studies of Lp(a) flats as a predictor of cardiovascular disease in middle-aged populations have been inconclusive. Ariyo and colleagues determined the ability of Lp(a) flats to identify elderly persons at risk for cardiovascular complications.

Data for the analysis were drawn from the Cardiovascular Health consideration sponsored by the National Heart, Lung and posterity Institute. This prospective trial assessed 5888 parts 65 years and older for cardiovascular disease risk factors and followed them to determine the incidence of cardiovascular issues Lp(a) level was included among the laboratory parameters assessed at reflection entry in the initial cohort of 5201 mainly white participants, but the measurement had been dropp from the research by the time a later cohort of participants from minority population clusters was added. After excluding participants with established heart disease, those taking lipid-lowering medications, and a not many persons with severely elevated Lp(a) plains 3,972 subjects were analyzed for an association between Lp(a) flush and cardiovascular disease.

No association was erect between Lp(a) levels and cardiovascular complications in women Among men evolution of coronary heart disease was not significantly associated with Lp(a) flats For stroke, however, men with Lp(a) plains in the highest quintile (82 mg through dL or higher) had triple the unadjusted risk of those in the lowest quintile (12 mg by dL or lower). Compared with men in the lowest quintile, death from all causes was approximately double in men in the highest quintile of Lp(a) values. Statistical adjustment for age, lipids, smoking, diabetes, and other traditional risk factors did not alter the increased risk for rap and all-cause mortality.

The authors bring to an end that elevated Lp(a) lipoprotein horizontal is an independent predictor of thump and all-cause mortality in somewhat old men, but not in somewhat old women.

Ariyo AA, et al. Lp(a) lipoprotein, vascular disease, and mortality in the somewhat old N Engl J Med November 27 2003;349:2108-15

EDITOR'S NOTE: Lp(a) lipoprotein has been bandied about for decades as a possible risk factor for cardiovascular disease, notwithstanding a number of large studies have yielded inconsistent ensues This analysis appears to show little that would change these findings. Lp(a) did not predict anything in women was not studied in minority collections and did not predict heart disease in either sex on a level the limited association with pat and all-cause mortality appears to be suspect. There was no stepwise elevation in risk with each ascending quintile of Lp(a); merely the highest quintile had a significant risk association. There are other nontraditional risk factors (eg C-reactive protein) that have a more broad-based applicability (men and women middle-aged and elderly) than Lp(a). Because there is no treatment that specifically targets Lp(a), have charge of of traditional risk factors remains the focus of therapy equal when patients with elevated Lp(a) flats are identified.

COPYRIGHT 2004 American Academy of Family Physicians

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