Estrogen and Progestin, Lipoprotein(a), and the Risk of Recurrent Coronary Heart Disease Events After Menopause
JAMAPublished 12 April 2000
Michael G. Shlipak
Citations365
SJR quartileQ1
SJR score5.35
SNIP10.71
Generate an AI Snapshot to get a quick, structured summary of this paper.
Study Snapshot
ObjectiveStudy objective
MethodsResearch methodology
PopulationPopulation studied
Sample sizeSample sizes
OutcomesStudy outcomes here
ResultsStudy results comes here
LimitationsResearch study limitations comes here
A concise AI-generated summary of the paper will appear here once you click Generate AI Snapshot.
TL;DR
The data suggest that Lp (a) is an independent risk factor for recurrent CHD in postmenopausal women and that treatment with estrogen and progestin lowers Lp(a) levels.
Abstract
Our data suggest that Lp(a) is an independent risk factor for recurrent CHD in postmenopausal women and that treatment with estrogen and progestin lowers Lp(a) levels. Estrogen and progestin therapy appears to have a more favorable effect (relative to placebo) in women with high initial Lp(a) levels than in women with low levels. This apparent interaction needs confirmation in other trials.
Keywords
MedicineBiochemistry, Genetics and Molecular Biology
JAMARandomized Trial of Estrogen Plus Progestin for Secondary Prevention of Coronary Heart Disease in Postmenopausal Women
6,229 Citations1998Stephen B. Hulley
Treatment with oral conjugated equine estrogen plus medroxyprogesterone acetate did not reduce the overall rate of CHD events in postmenopausal women with established coronary disease and the treatment did increase the rate of thromboembolic events and gallbladder disease.
Journal of the American College of CardiologyFifteen year mortality in Coronary Drug Project patients: Long-term benefit with niacin
1,841 Citations1986Paul L. Canner, Kenneth G. Berge +5 more
The Coronary Drug Project was conducted to assess the long-term efficacy and safety of five lipid-influencing drugs in 8,341 men aged 30 to 64 years with electrocardiogram-documented previous myocardial infarction, and niacin treatment showed modest benefit in decreasing definite nonfatal recurrent myocardia but did not decrease total mortality.
JAMAA Prospective Study of Lipoprotein(a) and the Risk of Myocardial Infarction
499 Citations1993Paul M. Ridker
The data do not support the use of Lp(a) level as a screening tool to define cardiovascular risk among this population of predominantly middle-aged white men, and no evidence of association between Lp-a level and risk of future MI is found.
JAMALipoprotein(a) Levels and Risk of Coronary Heart Disease in Men
486 Citations1994Ernst J. Schaefer
The data are consistent with the concept that an elevated Lp(a) level is an independent risk factor for CHD in hypercholesterolemic white men.
The American Journal of CardiologyHypertriglyceridemia and elevated lipoprotein (a) are risk factors for major coronary events in middle-aged men
454 Citations1996Gerd Assmann, H. Schulte +1 more
Interestingly, this analysis revealed a significant and independent association between serum levels of triglycerides and the incidence of major coronary events and lipoprotein(a) levels are sensitive indicators of increased riskmajor coronary events.
Arteriosclerosis An Official Journal of the American Heart Association IncDetection and quantification of lipoprotein(a) in the arterial wall of 107 coronary bypass patients.
450 Citations1989Matthias Rath, Axel Niendorf +4 more
This initial study showed that Lp(a) accumulates in the arterial wall, partly in the form of lipoprotein-like particles, therefore contributing to plaque formation and coronary heart disease.
Journal of Internal MedicinePronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid
447 Citations1989Lars A. Carlson, Anders Hamsten +1 more
Pronounced lowering of serum levels of lipoprotein Lp(a) in hyperlipidaemic subjects treated with nicotinic acid is reported.
JAMAElevated Plasma Lipoprotein(a) and Coronary Heart Disease in Men Aged 55 Years and Younger
394 Citations1996Andrew G. Bostom
Elevated plasma Lp(a) is an independent risk factor for the development of premature CHD in men, comparable in magnitude and prevalence (ie, attributable risk) to a total cholesterol level of 6.2 mmol/L (240 mg/dL) or more, or an HDL level less than 0.3%.
AtherosclerosisLipoprotein (a) and coronary heart disease risk: a nested case-control study of the Helsinki Heart Study participants
358 Citations1991Matti Jauhiainen, Pekka Koskinen +5 more
It is concluded that in the Helsinki Heart Study cohort the serum Lp(a) level was not a predictor of future coronary events.
Clinical ChemistryEffect of the number of apolipoprotein(a) kringle 4 domains on immunochemical measurements of lipoprotein(a)
350 Citations1995Santica M. Marcovina, J. Albers +3 more
It is concluded that antibody specificity and apo(a) size heterogeneity can significantly affect Lp(a), as determined by a high-resolution phenotyping system.
CirculationHMG CoA reductase inhibitors lower LDL cholesterol without reducing Lp(a) levels.
341 Citations1989Gerhard M. Kostner, Dov Gavish +4 more
The surprising finding of an increase in Lp(a) levels suggests this class of drugs may have a direct effect on Lp (a) synthesis or clearance independent of its effect on LDL receptors.
CirculationEffects of age, sex, and menopausal status on plasma lipoprotein(a) levels. The Framingham Offspring Study.
340 Citations1993J L Jenner, José M. Ordovás +5 more
In this population of men and women participating in the Framingham Offspring Study, there was an inverse association between plasma levels of Lp(a) and triglycerides for both sexes (p<0.006), but triglycerides accounted for only approximately 0.5% of the variation in Lp (a) levels.
Clinical GeneticsLp(a) lipoprotein and pre‐β<sub>1</sub>‐lipoprotein in patients with coronary heart disease
314 Citations1974Kåre Berg, Gösta Dahlén +1 more
Certain properties of the atypical serum lipop Protein, referred to as pre‐β1‐lipoprotein, suggested that it might be identical to the lipoprotein carrying the Lp(a) antigen: Lp (a) lipop protein, which occurs in a certain proportion of healthy people.
European Journal of Clinical InvestigationLipoprotein Lp(a) as predictor of myocardial infarction in comparison to fibrinogen, LDL cholesterol and other risk factors: results from the prospective Göttingen Risk Incidence and Prevalence Study (GRIPS)
303 Citations1994Peter Cremer, D. Nagel +5 more
The GRIPS data strongly support strategies for the identification and treatment of persons at increased MI risk which focus on LDL cholesterol, but Lp(a) and fibrinogen have to be seriously considered as additional risk factors and should be included in diagnostic panels for the estimation of MI risk.
Controlled Clinical TrialsHeart and Estrogen/progestin Replacement Study (HERS)
256 Citations1998Deborah Grady, William B. Applegate +4 more
The trial was designed to have power greater than 90% to detect a 35% reduction in the incidence of CHD events, assuming a 50% lag in effect for 2 years and a 5% annual event rate in the placebo group.
CirculationA prospective investigation of elevated lipoprotein (a) detected by electrophoresis and cardiovascular disease in women. The Framingham Heart Study.
255 Citations1994Andrew G. Bostom, David Gagnon +6 more
Band presence and, equivalently, elevated plasma lipoprotein (a), was a strong, independent predictor of myocardial infarction, intermittent claudication, and cerebrovascular disease in Framingham Heart Study women.
The LancetApolipoproteins and ischaemic heart disease: implications for screening
244 Citations1994Nicholas Wald, Hilary Watt +4 more
JAMALipoprotein(a). A genetic risk factor for premature coronary heart disease
228 Citations1992A M Scanu
The American Journal of CardiologyPredictive value of apolipoproteins in a prospective survey of coronary artery disease in men
192 Citations1992Gunnar Sigurðsson, Asdis Baldursdottir +4 more
The present results illustrate additional importance of apo-AI and apo(a) concentrations in predicting coronary artery disease among Icelandic men, whereas api-B did not contribute anything further to the prediction than serum total cholesterol.
New England Journal of MedicineEstrogen and Progestin Compared with Simvastatin for Hypercholesterolemia in Postmenopausal Women
191 Citations1997Giselle M. Darling, Jennifer Johns +2 more
In postmenopausal women with hypercholesterolemia, therapy with estrogen plus progestin has beneficial effects on lipoprotein levels, and Hormone therapy may be an effective alternative to treatment with simvastatin, especially in women with normal triglyceride levels.
The American Journal of CardiologyLipoprotein(a) as a risk factor for coronary artery disease
181 Citations1998Santica M. Marcovina, Marlys L. Koschinsky
Since its identification by Kåre Berg in 1963, lipoprotein(a) [Lp(a)] has become a focus of research interest owing to the results of case-control and prospective studies linking elevated plasma levels of this lipop protein with the development of coronary artery disease and speculation about the origin of these fragments and their possible function in the atherosclerotic process.
Archives of Internal MedicineLipoprotein Lp(a) Excess and Coronary Heart Disease
178 Citations1997James H. Stein
An evidence-based approach is provided to the screening and treatment of patients with lipoprotein Lp(a) excess for patients with premature coronary atherosclerosis, a strong family history of premature atheros sclerosis, or refractory hypercholesterolemia.
PubMedMetabolic impact of adding medroxyprogesterone acetate to conjugated estrogen therapy in postmenopausal women. The Menopause Study Group.
168 Citations1994Lobo Ra, Pickar Jh +3 more
MetabolismLp(a) lipoprotein: Relationship to sinking pre-β lipoprotein, hyperlipoproteinemia, and apolipoprotein B
152 Citations1975John J. Albers, Veneracion G. Cabana +2 more
Findings suggest that Lp(a) is metabolically independnet of low density lipoprotein even though it shares the same structural protein, apoprotein B, as well as compared to the normolipidemic group.
Archives of Internal MedicineThe Lowering of Lipoprotein[a] Induced by Estrogen Plus Progesterone Replacement Therapy in Postmenopausal Women
146 Citations1993Maurizio R. Soma
The results suggest that in estrogen plus progesterone-treated postmenopausal women, the lipid profile is improved not only by lowering low-density lipoprotein cholesterol levels and raising high-densitylipoprotein levels, but also by lowering plasma Lp[a] concentrations.
Clinical GeneticsLp(a) lipoprotein level predicts survival and major coronary events in the Scandinavian Simvastatin Survival Study
137 Citations1997Kåre Berg, Gösta Dahlén +4 more
The findings show that Lp(a) lipoprotein predicts major coronary events as well as death in secondary prevention with Simvastatin, and independent confirmation that a high Lp (a)lipoprotein level is a significant coronary heart disease risk factor is provided.
Archives of Internal MedicineEffect of Postmenopausal Estrogen Replacement on Plasma Lp(a) Lipoprotein Concentrations
114 Citations1994Frank M. Sacks
Estrogen decreases the plasma Lp(a) lipoprotein concentration, which could explain some of the protective effect of estrogen replacement therapy on coronary heart disease.
AtherosclerosisA prospective study of obesity, lipids, apolipoproteins and ischaemic heart disease in women
65 Citations1992Michel P. Coleman, T J Key +7 more
The increased risks associated with increased Quetelet's index and total cholesterol were independent of each other and these variables were more strongly related to myocardial infarction than to angina.
PubMedEffect of hormone replacement therapy on lipoprotein(a) and lipid levels in postmenopausal women. Influence of various progestogens and duration of therapy.
62 Citations1996C J Kim, Young Ki Min +3 more
Archives of Internal MedicineEffect of Oral Estradiol on Lp(a) and Other Lipoproteins in Postmenopausal Women
57 Citations1996Christopher J. Haines
The results of this study confirm the beneficial effect of oral estradiol on the basic lipop protein pattern and demonstrate that this treatment is effective in reducing concentrations of Lp(a) lipoprotein in postmenopausal women.
HypertensionEffect of risk status on treatment criteria. Implications of hypertension trials.
41 Citations1989Warren S. Browner, S. B. Hulley
The cutoff point for treatment differs in different individuals: setting a single treatment threshold and goal for the entire population is not appropriate.
The American Journal of CardiologyClinical profiles of plain versus sustained-release niacin (niaspan) and the physiologic rationale for nighttime dosing
38 Citations1998Robert H. Knopp
AtherosclerosisExtraction of lipoprotein(a), apo B, and apo E from fresh human arterial wall and atherosclerotic plaques
37 Citations1995Tjark Reblin, Nicolette Meyer +3 more
It is confirmed that Lp(a) accumulates in the arterial wall, preferentially in diseased tissue, and that L p( a) particles, deposited in atherosclerotic plaques, are partly degraded to LDL-like particles and free apo(a).
AtherosclerosisReduction of serum lipoprotein(a) levels in hyperlipidaemic patients with α-tocopheryl nicotinate
36 Citations1990Akio Noma, Shin Maeda +3 more
Serum lipids, lipoproteins and apolipoproteins, except for Lp(a), tended to increase after treatment, but changes in HDL-cholesterol and apo C-II levels were statistically significant, on the other hand, serum Lp (a) levels in all patients decreased significantly after 2 months of treatment.