Lipoprotein(a), Ethnicity, and Cardiovascular Risk: Erasing a Paradox and Filling a Clinical Gap
For more than 20 years, textbooks of medicine and guidelines for cardiovascular risk screening have suggested that elevated levels of lipoprotein(a) [Lp(a)] are a risk marker for coronary heart disease in Caucasian populations, but not among African Americans. This observation, included in the Adult Treatment Panel III guidelines in 20021, has long been puzzling as African Americans have both higher Lp(a) levels and higher absolute cardiovascular event rates when compared to age and gender matched Caucasians. Many explanations for this assumed ethnicity based Lp(a) paradox have been described in the cardiovascular literature including effect modification on the basis of diverse environmental and social influences, as well as genetic differences related to variation in kringle IV type 2 copy number. In retrospect, however, this embedded piece of preventive cardiology wisdom may prove to be a faux clinical pearl that entered the literature due to little more than poor statistical power. (SELECT FULL TEXT TO CONTINUE)
- Received November 8, 2011.
- Accepted November 10, 2011.
- Copyright © 2011, American Heart Association, Inc. All rights reserved. Unauthorized use prohibited