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Clin Cardiol. 2016 Feb;39(2):96-102. doi: 10.1002/clc.22500. Epub 2016 Feb 16.

Lipoprotein(a) and Increased Cardiovascular Risk in Women.

Author information

1
Division of Cardiology, Rush University Medical Center, Chicago, Illinois.
2
Division of Cardiology, John H. Stroger, Jr. Hospital of Cook County, Chicago, Illinois.
3
Division of Neurology, Rush University Medical Center, Chicago, Illinois.
4
Department of Internal Medicine, Rush University Medical Center, Chicago, Illinois.
5
Division of Cardiology, Emory University School of Medicine, Atlanta, Georgia.

Abstract

BACKGROUND:

Approximately 20% of the population has elevated circulating levels of lipoprotein(a) (Lp[a]), one of the most robust predictors of cardiovascular disease risk. This is particularly true for women.

HYPOTHESIS:

Many female patients with "normal" traditional risk factors or low atherosclerotic cardiovascular disease (ASCVD) risk scores may harbor high risk related to elevated levels of Lp(a).

METHODS:

A retrospective, cross-sectional study of consecutive female patients presenting to Heart Centers for Women was performed. Discordance between low-density lipoprotein cholesterol (LDL-C) and Lp(a) was determined. The ASCVD risk and Reynolds Risk Score models A (RRS-A) and B (RRS-B) were calculated, and level of agreement in patients meeting treatment threshold (≥7.5% for ASCVD, ≥10% for RRS-A and RRS-B) were compared.

RESULTS:

Among 713 women, 290 (41%) had elevated Lp(a); however, LDL-C and Lp(a) were weakly correlated (r = 0.08). Significant discordance was observed between abnormal LDL-C and Lp(a) levels (McNemar P = 0.03). There was moderate correlation between RRS-A and ASCVD risk (r = 0.71, P < 0.001), and Bland-Altman plot showed diminished correlation with increased risk. More patients met treatment threshold by ASCVD risk estimation, but nearly 1 out of 20 patients met treatment threshold by RRS-A but not ASCVD score.

CONCLUSIONS:

There is high prevalence of elevated Lp(a) among women presenting to Heart Centers for Women. Although traditional risk markers such as elevated LDL-C or high ASCVD risk may be absent in some women, elevated Lp(a) may identify patients who may benefit from aggressive risk-factor modification and pharmacologic therapy.

PMID:
26880352
DOI:
10.1002/clc.22500
[Indexed for MEDLINE]
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