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Lipoprotein(a) in coronary heart disease. Is it a risk factor after all?

The role of lipoprotein(a) [Lp(a)] in coronary heart disease (CHD), once considered to be well established, has recently been put into question. For example, in a prospective, nested case-control study of the Helsinki Heart Study participants, Jauhiainen et al 1 found no significant increase in risk of CHD associated with higher levels of Lp(a) among 138 hyperlipidemic men who developed coronary events compared with 130 controls. A similar lack of association between Lp(a) and clinical CHD was reported by Simons et al 2 from a cross-sectional analysis of 1202 men and 1512 women older than 60 years. The skewed and broad distribution of Lp(a) levels, ranging from 1.0 mg/dL (0.03 mmol/L) to 210.0 mg/dL (5.25 mmol/L), was strikingly similar in the two groups. Finally, in a report published recently inThe JOURNALinvolving the prospective Physicians' Health Study, Ridker et al 3 found a "virtually identical" Lp(a) distribution among 296