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(Stroke. 2006;37:1350.)
© 2006 American Heart Association, Inc.

Editorials

Lipoprotein(a)

Involved in Events, but Not Burden of Atherosclerotic Disease?

J. David Spence, MD, FRCPC, FAHA

From the Stroke Prevention & Atherosclerosis Research Centre, London, ON, Canada.

Correspondence to Dr David Spence, Stroke Prevention & Atherosclerosis Research Centre, 1400 Western Rd, London, ON, Canada N6G 2V2. E-mail dspence@robarts.ca

Key Words: artery plaques, carotid • cerebrovascular disorders • intima-media thickness • Lp(a) • lipoprotein(a) • thrombosis

An extract of the first 250 words of the full text is provided, because this article has no abstract.

In this issue of Stroke, the Atherosclerosis Risk in Communities (ARIC) study provides evidence that lipoprotein(a) [Lp(a)] is a significant predictor of stroke.¹ This is an important finding, because ARIC is both large and prospective. Over 14 000 patients were enrolled in 1987 to 1989, and during 13.5 years of follow-up, they experienced 496 ischemic strokes. Lp(a) remained a significant predictor of stroke after adjustment for age, race, systolic blood pressure, antihypertensive medication, smoking status, use of postmenopausal hormone therapy, diabetes, LDL cholesterol, HDL cholesterol, fibrinogen, and von Willebrand factor. It thus seems likely that Lp(a) is potentially an important treatable risk factor.

But what is Lp(a), and how does it relate to atherosclerosis and cardiovascular events? A meta-analysis of prospective studies of coronary events² seems to establish that Lp(a) is also a predictor of myocardial infarction, but numerous studies indicate that it does not seem to predict the burden of atherosclerosis as assessed by intima-media thickness,^3,4 except perhaps in patients with renal failure.⁵ Rossl et al⁶ found that Lp(a) was not associated with IMT or plaque but was associated with stenosis of carotid arteries.

We have previously shown that carotid plaque area more strongly predicts vascular outcomes than does stenosis assessed by carotid Doppler velocities^7,8; an analysis of that database prompted by this commentary (previously unpublished) showed that in multiple regression adjusted for age, sex, systolic blood pressure and pack-years of smoking, Lp(a) was not associated with baseline plaque area (P=0.59), but was associated with . . . [Full Text of this Article]

Related Article:

Lipoprotein(a) and Incident Ischemic Stroke: The Atherosclerosis Risk in Communities (ARIC) Study

Tetsuya Ohira, Pamela J. Schreiner, Joel D. Morrisett, Lloyd E. Chambless, Wayne D. Rosamond, and Aaron R. Folsom
Stroke 2006 37: 1407-1412. [Abstract] [Full Text] [PDF]

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