LIPOPROTEIN(A) AS A RISK FACTOR FOR ISCHEMIC-HEART-DISEASE - METAANALYSIS OF PROSPECTIVE STUDIES

Although in vitro studies support a pathophysiologic role for lipoprot ein(a) [Lp(a)] in the development of atherosclerosis, and retrospectiv e studies consistently report that there is a relationship between Lp( a) and ischemic heart disease (IHD), the conclusions drawn from prospe ctive studies about this relationship have been inconsistent. To addre ss this issue, we have performed a metaanalysis of data available from prospective studies. Lp(a) concentrations expressed as mass units var y markedly between studies, reflecting the need for assay standardizat ion. In 12 of 14 prospective studies, Lp(a) concentrations are higher in subjects who later develop IHD (cases) than in those who do not (co ntrols), although there is variation in the size of the effect. Sample storage temperature may contribute to this variability. When the stud ies are analyzed collectively, Lp(a) concentrations are significantly higher in cases than in controls, and the extent of the effect is simi lar in men and women. These findings provide evidence in support of a causal role for Lp(a) in the development of atherosclerosis. Measureme nt of Lp(a) may be useful to guide management of individuals with a fa mily history of IHD or with existing disease. The separation in values between cases and controls is not, however, sufficient to allow the u se of Lp(a) as a screening test in the general population.