Lipoprotein(a) and Women
- Elevated lipoprotein(a) (Lp(a)) is one of the foremost risk factors for premature CAD (coronary artery disease) in women as well as peripheral, and cerebrovascular disease.1-7
- High levels of Lp(a) is a strong risk factor for the occurrence and recurrence of coronary events and the need for coronary procedures (such as angioplasty, stent, or bypass surgery) in postmenopausal women.8 High Lp(a) level confer a 3-fold risk of CAD in diabetic women as measured by coronary artery calcium score (heart scan).9
- Heart attack in premenopausal women is 10 times less common than men of comparable age except among Asian Indian women.10 The risk from elevated Lp(a) appears to be double in premenopausal women than in postmenopausal women.11-13
- The risk of CAD is markedly increased as high as 100-fold among women who have very high levels of Lp(a) (>55mg/dl) and very high TC/HDL ratio (>5.8).2, 3 High prevalence of this combination accounts for their very high risk of severe CAD in Asian Indian women, young and old alike.10, 14-16
- Elevated Lp(a) level is also a major determinant of thromboembolic complications during pregnancy, including heart attack.4, 17, 18 There is a 2-fold increase in Lp(a) during normal pregnancy, which may influence fibrinolysis.
- Other conditions in women associated with elevated Lp(a) include endometriosis, antiphospholipid antibody syndrome, severe preeclampsia, eclampsia, HELLP Syndrome, and recurrent miscarriages.19-25
- The increased risk of CAD in postmenopausalwomen appears to be mediated in part by a 25% increase in theLp(a) levels that occurs after menopause.26
- In subjects with high Lp(a) levels, estrogen replacement therapy resultsin a 50% reduction in Lp(a) levels as well a 50% reduction in coronary events and need for coronary interventions such as angioplasty and bypass surgery.27 However, estrogen therapy is currently not recommended as a treatment for elevated Lp(a).15
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2. Wang XL, Cranney G, Wilcken DE. Lp(a) and conventional risk profiles predict the severity of coronary stenosis in high-risk hospital-based patients. Aust N Z J Med. 2000;30(3):333-338.
3. Solymoss BC, Marcil M, Wesolowska E, Gilfix BM, Lesperance J, Campeau L. Relation of coronary artery disease in women 60 years of age to the combined elevation of serum lipoprotein (a) and total cholesterol to high-density cholesterol ratio. Am J Cardiol. 1993;72(17):1215-1219.
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