ELEVATED PLASMA LIPOPROTEIN(A) AND CORONARY HEART-DISEASE IN MEN AGED55 YEARS AND YOUNGER - A PROSPECTIVE-STUDY

Objective.-To establish whether elevated lipoprotein(a) [Lp(a)], detec ted as a sinking pre-beta-lipoprotein band on electrophoresis of fresh plasma, is an independent risk factor for the development of prematur e coronary heart disease (CHD) in men. Design and Setting.-Prospective study of the Framingham offspring cohort. Participants.-A total of 21 91 men aged 20 to 54 years old who were free of cardiovascular disease when they were examined between 1971 and 1975. Main Outcome Measures. -Incident CHD (myocardial infarction, coronary insufficiency, angina p ectoris, or sudden cardiac death) occurring by age 55 years. Results.- After a median follow-up of 15.4 years, there were 129 CHD events. The relative risk (RR) estimates (with 95% confidence intervals [Cls]) fo r premature CHD derived from a proportional hazards model that include d age, body mass index, and the dichotomized risk factor covariables e levated plasma Lp(a) level, total cholesterol level of 6.2 mmol/L (240 mg/dL) or more, high-density lipoprotein (HDL) level less than 0.9 mm ol/L (35 mg/dL), smoking, glucose intolerance, and hypertension were a s follows: elevated Lp(a) level, RR, 1.9 (95% Cl, 1.2-2.9), prevalence , 11.3%; total cholesterol level of 6.2 mmol/L or more, RR, 1.8 (95% C l, 1.2-2.7), prevalence, 14.3%; HDL level of less than 0.9 mmol/L, RR, 1.8 (95% Cl, 1.2-2.6), prevalence, 19.2%; smoking, RR, 3.6 (95% Cl, 2 .2-5.5), prevalence, 46.7%; glucose intolerance, RR, 2.7 (95% Cl, 1.4- 5.3), prevalence, 2.6%; hypertension, RR, 1.2 (95% Cl, 0.8-1.8), preva lence, 26.3%. Conclusions.-Elevated plasma Lp(a) is an independent ris k factor for the development of premature CHD in men, comparable in ma gnitude and prevalence (ie, attributable risk) to a total cholesterol level of 6.2 mmol/L (240 mg/dL) or more, or an HDL level less than 0.9 mmol/L (35 mg/dL).