Journal article
Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality
JAMA : the journal of the American Medical Association, Vol.302(4), pp.412-423
07/22/2009
DOI: 10.1001/jama.2009.1063
PMCID: PMC3272390
PMID: 19622820
Abstract
CONTEXTCirculating concentration of lipoprotein(a) (Lp[a]), a large glycoprotein attached to a low-density lipoprotein-like particle, may be associated with risk of coronary heart disease (CHD) and stroke. OBJECTIVETo assess the relationship of Lp(a) concentration with risk of major vascular and nonvascular outcomes. STUDY SELECTIONLong-term prospective studies that recorded Lp(a) concentration and subsequent major vascular morbidity and/or cause-specific mortality published between January 1970 and March 2009 were identified through electronic searches of MEDLINE and other databases, manual searches of reference lists, and discussion with collaborators. DATA EXTRACTIONIndividual records were provided for each of 126,634 participants in 36 prospective studies. During 1.3 million person-years of follow-up, 22,076 first-ever fatal or nonfatal vascular disease outcomes or nonvascular deaths were recorded, including 9336 CHD outcomes, 1903 ischemic strokes, 338 hemorrhagic strokes, 751 unclassified strokes, 1091 other vascular deaths, 8114 nonvascular deaths, and 242 deaths of unknown cause. Within-study regression analyses were adjusted for within-person variation and combined using meta-analysis. Analyses excluded participants with known preexisting CHD or stroke at baseline. DATA SYNTHESISLipoprotein(a) concentration was weakly correlated with several conventional vascular risk factors and it was highly consistent within individuals over several years. Associations of Lp(a) with CHD risk were broadly continuous in shape. In the 24 cohort studies, the rates of CHD in the top and bottom thirds of baseline Lp(a) distributions, respectively, were 5.6 (95% confidence interval [CI], 5.4-5.9) per 1000 person-years and 4.4 (95% CI, 4.2-4.6) per 1000 person-years. The risk ratio for CHD, adjusted for age and sex only, was 1.16 (95% CI, 1.11-1.22) per 3.5-fold higher usual Lp(a) concentration (ie, per 1 SD), and it was 1.13 (95% CI, 1.09-1.18) following further adjustment for lipids and other conventional risk factors. The corresponding adjusted risk ratios were 1.10 (95% CI, 1.02-1.18) for ischemic stroke, 1.01 (95% CI, 0.98-1.05) for the aggregate of nonvascular mortality, 1.00 (95% CI, 0.97-1.04) for cancer deaths, and 1.00 (95% CI, 0.95-1.06) for nonvascular deaths other than cancer. CONCLUSIONUnder a wide range of circumstances, there are continuous, independent, and modest associations of Lp(a) concentration with risk of CHD and stroke that appear exclusive to vascular outcomes.
Details
- Title: Subtitle
- Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality
- Creators
- Sebhat Erqou - University of CambridgeStephen Kaptoge - University of CambridgePhilip L Perry - University of CambridgeEmanuele Di Angelantonio - Karolinska InstitutetAlexander Thompson - University of CambridgeIan R WhiteSantica M Marcovina - University of WashingtonRory CollinsSimon G ThompsonEmerging Risk Factors CollaborationJohn Danesh - University of Cambridge
- Contributors
- Robert B Wallace (Contributor) - University of Iowa, Internal Medicine
- Resource Type
- Journal article
- Publication Details
- JAMA : the journal of the American Medical Association, Vol.302(4), pp.412-423
- DOI
- 10.1001/jama.2009.1063
- PMID
- 19622820
- PMCID
- PMC3272390
- NLM abbreviation
- JAMA
- ISSN
- 0098-7484
- eISSN
- 1538-3598
- Language
- English
- Date published
- 07/22/2009
- Academic Unit
- Epidemiology; Injury Prevention Research Center; Internal Medicine
- Record Identifier
- 9984364438802771
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