Caution is needed in interpreting the results because all the people in the studies were white, Nordestgaard said. "People of African descent have the highest lipoprotein(a) levels, while those of European descent and most Asians have similar levels, but lower levels than blacks," he noted.
The studies of LPA levels and heart disease in ethnic groups other than whites have been limited, Nordestgaard said. "It is likely that high lipoprotein(a) levels are also important in other ethnic groups, but we need new and much larger studies to confirm this," he said.
The findings could influence medical efforts to reduce heart attack risk, Nordestgaard said. "People who develop heart attacks despite cholesterol-lowering statin treatment may have high levels of lipoprotein(a)," he said. "Also, in medium-risk individuals, an elevated lipoprotein(a) level may suggest that the patient should be given a statin or niacin."
The new study is "an elegant biological demonstration of the link between lipoprotein(a) and heart attack," said Dr. Christopher J. O'Donnell, associate director of the U.S. National Heart, Lung, and Blood Institute's Framingham Heart Study, and co-author of an accompanying editorial
"But it doesn't alter the balance of evidence that to date doesn't support doing a test on the serum level or a genetic test for LPA," O'Donnell said. "There would have to be some type of evidence that direct treatment of LPA lowers the risk or that a subgroup of people with an elevated risk have their risk lowered in some way."
Such evidence would have to come from a truly large-scale study, O'Donnell said. "We would have to screen an entire population," he said. Meanwhile, there is "no compelling evidence" that LPA-lowering therapy would affect coronary risk, he said.
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