Epidemiology
Lp(a) triples coronary risk in men with low HDL cholesterol, the PROCAM study of 788 men (J Am Coll Cardiol 2001)
Original title: Lipoprotein(a) further increases the risk of coronary events in men with high global cardiovascular risk
This prospective study followed 788 men aged 35-65 from the Prospective Cardiovascular Munster (PROCAM) study for 10 years, comparing 44 who had a myocardial infarction with 744 who remained event-free, to assess Lp(a) as a coronary risk factor alongside traditional risk factors. Overall, men with Lp(a) at or above 0.2 g/L had 2.7 times the coronary event risk of those with lower levels (95% CI 1.4-5.2), an increase most pronounced in men with LDL cholesterol at or above 4.1 mmol/L (relative risk 2.6, 95% CI 1.2-5.7), HDL cholesterol at or below 0.9 mmol/L (relative risk 8.3, 95% CI 2.0-35.5), hypertension (relative risk 3.2, 95% CI 1.4-7.2), or in the two highest global risk quintiles (relative risk 2.7, 95% CI 1.3-5.7). The findings show Lp(a) increases coronary risk, especially in men with high LDL cholesterol, low HDL cholesterol, hypertension, or high overall cardiovascular risk.
Original abstract
Objectives: This prospective population study was conducted to assess the role of elevated lipoprotein(a) [Lp(a)] as a coronary risk factor.
Background: The role of elevated Lp(a) as a risk factor for coronary heart disease is controversial. In addition, little attention has been paid to the interaction of Lp(a) with other risk factors.
Methods: A total of 788 male participants of the Prospective Cardiovascular Münster (PROCAM) study aged 35 to 65 years were followed for 10 years. Both Lp(a) and traditional cardiovascular risk factors (e.g., age, low density lipoprotein [LDL] cholesterol, high density lipoprotein [HDL] cholesterol, triglycerides, systolic blood pressure, cigarette smoking, diabetes mellitus, angina pectoris, and family history of myocardial infarction) were evaluated in 44 men who suffered from myocardial infarction, and in 744 men who survived without major coronary events or stroke. A multiple logistic function algorithm was used to estimate global cardiovascular risk by the combined effects of traditional risk factors.
Results: Overall, the risk of a coronary event in men with an Lp(a) > or =0.2 g/liter was 2.7 times that of men with lower levels (95% confidence interval [CI]: 1.4 to 5.2). This increase in risk was most prominent in men with LDL cholesterol level > or =4.1 mmol/liter (relative risk [RR]: 2.6; 95% CI: 1.2 to 5.7), with HDL cholesterol < or =0.9 mmol/liter (RR 8.3; 95% CI: 2.0 to 35.5), with hypertension (RR 3.2; 95% CI: 1.4 to 7.2), or within the two highest global risk quintiles (relative risk: 2.7; 95% CI: 1.3 to 5.7).
Conclusions: Lp(a) increases the coronary risk, especially in men with high LDL cholesterol, low HDL cholesterol, hypertension and/or high global cardiovascular risk.
Summary written by lp-a.org from the published abstract; figures as published. Page updated 18 August 2026. Methods.