PREDICTIVE VALUE OF ELECTROPHORETICALLY DETECTED LIPOPROTEIN(A) FOR CORONARY HEART-DISEASE AND CEREBROVASCULAR-DISEASE IN A COMMUNITY-BASEDCOHORT OF 9936 MEN AND WOMEN

Background Elevated lipoprotein(a) [Lp(a)] levels have been associated with the presence of atherosclerotic disease. However, the results of prospective studies of Lp(a) and cardiovascular disease have been con tradictory. Methods and Results From 1968 through 1982, lipoprotein an alysis was performed in 11 335 Olmsted County residents. Quantitative cholesterol and triglycerides were obtained along with semiquantitativ e Lp(a) levels based on electrophoretic pattern. Lp(a) bands were scor ed from 0 (absent) to 3 (increased). A cohort of 4967 men and 4968 wom en with no prior history of atherosclerotic disease who had baseline L p(a) determinations were followed up for 14 years for development of c oronary artery disease (CAD) and cerebrovascular disease (CVD). During 131 330 person-years of follow-up, there were 1848 CAD events and 841 CVD events. Age, diabetes, hypertension, cholesterol, and triglycerid es were significantly and independently associated with an increased r isk of CAD and CVD in men and women. There was a significant increase in the adjusted hazards ratio for CAD with increasing Lp(a) levels for men and women. For Lp(a) level 3, the hazard ratio was 1.9 (range, 1. 3 to 2.9) in women and 1.6 (range, 1.0 to 2.5) in men. The adjusted ha zard ratio for CVD showed an irregular association with Lp(a) levels i n men and no association in women. Conclusions In this cohort of 9936 men and women initially free of cardiovascular disease who were follow ed up for 14 years, LP(a) was a significant-predictor of risk of futur e CAD. Lp(a) was a weak risk factor for CVD in men and was not a signi ficant predictor of CVD risk in women.