A PROSPECTIVE-STUDY OF LIPOPROTEIN(A) AND THE RISK OF MYOCARDIAL-INFARCTION

被引:449
作者
RIDKER, PM
HENNEKENS, CH
STAMPFER, MJ
机构
[1] BRIGHAM & WOMENS HOSP,DEPT PEDIAT,DIV CARDIOL,BOSTON,MA 02115
[2] BRIGHAM & WOMENS HOSP,DEPT PEDIAT,CHANNING LAB,BOSTON,MA 02115
[3] HARVARD UNIV,SCH MED,DIV AMBULATORY CARE & PREVENT,BOSTON,MA 02115
[4] HARVARD UNIV,SCH PUBL HLTH,DEPT EPIDEMIOL,BOSTON,MA 02115
来源
JAMA-JOURNAL OF THE AMERICAN MEDICAL ASSOCIATION | 1993年 / 270卷 / 18期
关键词
D O I
10.1001/jama.270.18.2195
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Objective.-To assess prospectively the risk of myocardial infarction (MI) associated with elevated levels of lipoprotein(a) (Lp[a]). Design.-Nested case-control study using prospectively collected plasma samples. Setting.-Participants in the Physicians' Health Study. Participants.-A total of 14 916 male physicians aged 40 to 84 years with no prior history of MI or stroke provided plasma samples at baseline and were followed up prospectively for an average period of 60.2 months. Samples from 296 physicians who subsequently developed MI were analyzed for Lp(a) level together with paired controls, matched for smoking status and age. Main Outcome Measure.-Fatal or nonfatal acute MI. Results.-The distribution of Lp(a) level among cases was virtually identical to that of controls (P=.88), and there was no significant difference between groups for median Lp(a) levels (103.0 mg/L vs 102.5 mg/L; P=.73). In analyses controlling for age and smoking status, we found no evidence of association between increasing level of Lp(a) and risk of MI (relative risks from lowest to highest quintiles of Lp(a): 1.00, 0.97, 0.83, 0.88, and 1.07; P for trend=.93) or a threshold effect at any pre-specified cutoff of Lp(a) level (relative risks associated with Lp[a] levels above the 25th, 50th, 75th, 90th, and 95th percentiles of the control distribution, respectively: 1.04, 1.00, 1.19, 1.00, and 1.07; all P values nonsignificant). Further adjustment for both lipid and nonlipid cardiovascular risk factors had no material impact. Conclusions.-In this prospective study of predominantly middle-aged white men, we found no evidence of association between Lp(a) level and risk of future MI. These data do not support the use of Lp(a) level as a screening tool to define cardiovascular risk among this population.
引用
收藏
页码:2195 / 2199
页数:5
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