Circulation, Vol 90, 1688-1695, Copyright © 1994 by American Heart Association
AG Bostom, DR Gagnon, LA Cupples, PW Wilson, JL Jenner, JM Ordovas, EJ Schaefer and WP Castelli
BACKGROUND: Sinking prebeta lipoprotein is a putative marker for elevated
levels of lipoprotein (a). Although prospective data suggest that increased
plasma lipoprotein (a) is an independent risk factor for coronary heart
disease in men, no prospective studies are available in women. METHODS AND
RESULTS: From 1968 through 1975, sinking prebeta lipoprotein was determined
by paper electrophoresis in 3103 women Framingham Heart Study participants
who were free of prevalent cardiovascular disease. A sinking prebeta
lipoprotein band was detectable in 434 of the women (14%) studied. The
median follow-up interval was approximately 12 years. Incident
cardiovascular disease was associated with band presence using a
proportional hazards model that included age, smoking, body mass index,
systolic blood pressure, glucose intolerance, low- and high-density
lipoprotein cholesterol, and ECG left ventricular hypertrophy.
Multivariable adjusted relative risk estimates (with 95% confidence
intervals) for outcomes in the band present versus absent groups were as
follows: myocardial infarction (82 events), 2.37 (1.48 to 3.81);
intermittent claudication (62 events), 1.94 (1.07 to 3.50); cerebrovascular
disease (83 events), 1.88 (1.12 to 3.15); total coronary heart disease (174
events), 1.61 (1.13 to 2.29); and total cardiovascular disease (305
events), 1.44 (1.09 to 1.91). A subset analysis indicated that band
presence was 50.9% sensitive and 95.4% specific for detecting plasma
lipoprotein (a) levels of > 30 mg/dL, the threshold value linked to
increased cardiovascular disease risk in men. CONCLUSIONS: Sinking prebeta
lipoprotein was a valid surrogate for elevated lipoprotein (a) levels in
Framingham Heart Study women. Band presence and, equivalently, elevated
plasma lipoprotein (a), was a strong, independent predictor of myocardial
infarction, intermittent claudication, and cerebrovascular disease.
Confirmation of these findings in other longitudinal studies of women is
needed.
ARTICLES
A prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women. The Framingham Heart Study
Framingham Heart Study, MA 01701.
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