03326nas a2200373 4500008004100000022001400041245007100055210006600126260001600192300001200208490000800220520231600228653000902544653002102553653001102574653001102585653001402596653001902610653000902629653001402638653003202652653002402684653001702708653001602725653001102741653002202752653001802774653002202792100002202814700001602836700001902852710004602871856003502917 2003 eng d a1533-440600aLp(a) lipoprotein, vascular disease, and mortality in the elderly.0 aLpa lipoprotein vascular disease and mortality in the elderly c2003 Nov 27 a2108-150 v3493 a

BACKGROUND: As compared with what is known about predictors of vascular events in middle-aged persons, less is known about these events in the elderly. Lp(a) lipoprotein, which plays an important part in atherothrombogenesis, has been associated with an increased risk of vascular disease. We investigated this relation among older U.S. adults.

METHODS: In a prospective study of 5888 community-dwelling older adults (65 years of age or older) in the United States, 2375 women and 1597 men who were free of vascular disease provided base-line serum samples for analysis for levels of Lp(a) lipoprotein. These 3972 subjects were followed for a median of 7.4 years to evaluate the development of stroke and to track deaths from vascular causes and all causes. The men and women were divided into quintile groups according to the Lp(a) lipoprotein level at base line.

RESULTS: Using Cox proportional-hazards models, we determined the risk associated with each quintile level of Lp(a) lipoprotein, with the lowest quintile serving as the reference group. As compared with those in the lowest quintile, men in the highest quintile had three times the unadjusted risk of stroke (relative risk, 3.00; 95 percent confidence interval, 1.59 to 5.65), almost three times the risk of death associated with vascular events (relative risk, 2.54; 95 percent confidence interval, 1.59 to 4.08), and nearly twice the risk of death from all causes (relative risk, 1.76; 95 percent confidence interval, 1.31 to 2.36). Adjustment for age; sex; the levels of total cholesterol, low-density lipoprotein cholesterol, and triglycerides; carotid-wall thickness; smoking status; the presence or absence of diabetes and systolic and diastolic hypertension; body-mass index; and other traditional risk factors had little effect on the final assessments. Similar analyses for women, which also included adjustment for estrogen use or nonuse, revealed no such relation.

CONCLUSIONS: Among older adults in the United States, an elevated level of Lp(a) lipoprotein is an independent predictor of stroke, death from vascular disease, and death from any cause in men but not in women. These data support the use of Lp(a) lipoprotein levels in predicting the risk of these events in older men.

10aAged10aCoronary Disease10aFemale10aHumans10aIncidence10aLipoprotein(a)10aMale10aMortality10aProportional Hazards Models10aProspective Studies10aRisk Factors10aSex Factors10aStroke10aSurvival Analysis10aUnited States10aVascular Diseases1 aAriyo, Abraham, A1 aThach, Chau1 aTracy, Russell1 aCardiovascular Health Study Investigators uhttps://chs-nhlbi.org/node/759