Lipoprotein[a] as a risk factor for preclinical atherosclerosis

Pamela J. Schreiner, Joel D. Morrisett, A. Richey Sharrett, Wolfgang Patsch, Herman A. Tyroler, Kenneth Wu, Gerardo Heiss

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126 Scopus citations


Elevated mean levels of lipoprotein[a] (Lp[a]) have been associated with symptomatic cardiovascular diseases such as clinically manifest myocardial infarction (MI), coronary artery disease, restenosis of coronary artery vein grafts after bypass, and a family history of MI. Associations of Lp[a] with arterial wall thickening in asymptomatic individuals previously have not been addressed and are evaluated in this report among participants of the Atherosclerosis Risk in Communities (ARIC) Study. Intima-media wall thickening in the extracranial carotid arteries was assessed noninvasively with B-mode ultrasonography; Lp[a] was measured as its total protein component. Individuals with wall thickening ≥90th percentile of the population maximum far-wall thickness were pair matched to participants <75th percentile of wall thickness by race, gender, center, 10-year age group, and time of examination. These selection criteria yielded 492 matched pairs, with 395 white pairs and 97 black pairs. The mean Lp[a] protein level for all black participants was 174.6 μg/mL compared with 77.8 μg/mL for whites. Conditional logistic regression analysis for the association of Lp[a] with case-control status yielded a statistically significant prevalence odds ratio (OR) estimate of 1.49, based on a 1-SD difference in Lp[a] protein, after adjusting for age, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, fibrinogen, hypertension, and cigarette smoking. None of these risk factors significantly altered the OR, in agreement with reports that Lp[a] is unaffected by environmental influences. In addition, no differential effect of Lp[a] protein on case-control status (effect modification) was observed by race, gender, low-density lipoprotein cholesterol, or fibrinogen in this population. We conclude that Lp[a] is an independent risk factor for intima-media carotid thickening in individuals free of prevalent cardiovascular disease. Further investigation of racial effects may benefit from a population-based analysis that includes additional black participants as well as from elucidation of apolipoprotein[a] polymorph differences between races and degree of wall thickening.

Original languageEnglish (US)
Pages (from-to)826-833
Number of pages8
JournalArteriosclerosis, thrombosis, and vascular biology
Issue number6
StatePublished - 1993


  • Atherosclerosis
  • B-mode ultrasonography
  • Lipoprotein[a]
  • Race


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