Lp(A) Levels and ApoE4 Allele Predictive of Coronary Events in Men
The Lp(a) marker has been used in many functional medicine lab’s coronary risk profiles for years now. And to that homocysteine, cholesterol, CRP, fibrinogen and several others and you get a very good picture of cardiovascular risk. Remember that many of today’s chronic diseases have more than one contributing factor–do you think checking only one factor (cholesterol) is anywhere near all we need to be doing these days to evaulate cardiovascular risk? I’ve got a better idea–save the money on the lab tests and just start leading a healthy lifestyle…
Am J Med 2001;110:22-32,71-72 Adjusted multivariate analysis revealed cholesterol level, diabetes, smoking status, diastolic blood pressure, Apo-AI, age, and Lp(a) as independent risk factors for cardiac events. Dr. Seed and colleagues found that “coronary events were lowest in the group with Lp(a) levels below 2.9 mg/dL (the 25th percentile), highest in those with levels higher than 26.3 mg/dL (the 75th percentile), and intermediate in the group with levels of 2.9 to 26.3 mg/dL.” In the second study, Dr. Angelo Scuteri and colleagues, from the National Institutes of Health, in Baltimore, measured apoE genotypes in 730 men and women who participated in the Baltimore Longitudinal Study of Aging. The researchers identified the apoE4 allele in 200 subjects. On follow-up, 104 of the 730 subjects had coronary events. These events were significantly more frequent in subjects with the apoE4 allele (20%) than in those without it (12%), Dr. Scuteri’s team reports. “In a multivariate model, apoE4 was an independent predictor of coronary events in men (risk ratio 2.9), but not in women (risk ratio 0.9),” they note. Dr. Scuteri and colleagues also found that cholesterol levels did not appear to mediate the association. Despite the findings of these two studies, Dr. Peter W. F. Wilson, from Boston University School of Medicine, maintains that there is nothing definitive about using these markers as predictors of cardiac events. In an accompanying editorial, he writes that “improvement in vascular disease risk prediction with apoE allele determination is marginal [and] for Lp(a), the situation is [even] more murky.”