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Previous Volume 349:2108-2115 November 27, 2003 Number 22 Next

	Full Text PDF PDA Full Text Perspective by Scanu, A. M. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background As compared with what is known about predictors of vascular events in middle-aged persons, less is known about these events in the elderly. Lp(a) lipoprotein, which plays an important part in atherothrombogenesis, has been associated with an increased risk of vascular disease. We investigated this relation among older U.S. adults.

Methods In a prospective study of 5888 community-dwelling older adults (65 years of age or older) in the United States, 2375 women and 1597 men who were free of vascular disease provided base-line serum samples for analysis for levels of Lp(a) lipoprotein. These 3972 subjects were followed for a median of 7.4 years to evaluate the development of stroke and to track deaths from vascular causes and all causes. The men and women were divided into quintile groups according to the Lp(a) lipoprotein level at base line.

Results Using Cox proportional-hazards models, we determined the risk associated with each quintile level of Lp(a) lipoprotein, with the lowest quintile serving as the reference group. As compared with those in the lowest quintile, men in the highest quintile had three times the unadjusted risk of stroke (relative risk, 3.00; 95 percent confidence interval, 1.59 to 5.65), almost three times the risk of death associated with vascular events (relative risk, 2.54; 95 percent confidence interval, 1.59 to 4.08), and nearly twice the risk of death from all causes (relative risk, 1.76; 95 percent confidence interval, 1.31 to 2.36). Adjustment for age; sex; the levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides; carotid-wall thickness; smoking status; the presence or absence of diabetes and systolic and diastolic hypertension; body-mass index; and other traditional risk factors had little effect on the final assessments. Similar analyses for women, which also included adjustment for estrogen use or nonuse, revealed no such relation.

Conclusions Among older adults in the United States, an elevated level of Lp(a) lipoprotein is an independent predictor of stroke, death from vascular disease, and death from any cause in men but not in women. These data support the use of Lp(a) lipoprotein levels in predicting the risk of these events in older men.

Source Information

From the Center for Cardiovascular Disease Prevention and Intervention, HeartMasters, Dallas, and the Division of Cardiology, Johns Hopkins Hospital, Baltimore (A.A.A.); the Department of Biostatistics, University of Washington, Seattle (C.T.); and the Department of Pathology, University of Vermont, Burlington (R.T.).

Address reprint requests to Dr. Ariyo at HeartMasters, 2411 Poinciana Place, Dallas, TX 75212 or at aa_ariyo{at}yahoo.com.

Full Text of this Article

Related Letters:

Lp(a) Lipoprotein, Vascular Disease, and Mortality in the Elderly
Saely C. H., Marte T., Drexel H., Kovesdy C. P., Ariyo A. A., Tracy R. P., Thach C.
Extract | Full Text | PDF  
N Engl J Med 2004; 350:1150-1152, Mar 11, 2004. Correspondence

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