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(Circulation. 1998;97:293-295.)
© 1998 American Heart Association, Inc.

Correspondence

Lipoprotein(a) as a Determinant of Coronary Heart Disease in Young Women: A Stronger Risk Factor Than Diabetes?

Enas A. Enas, MD, FACC

Medical Director, Rockford Cardiology Lipid Clinic, Rockford, Ill

To the Editor:

The age-standardized mortality rates for coronary artery disease among women is about one half to one fourth that of men, although this rate varies more than 10-fold among men as well as women worldwide. This phenomenon is due to the well-known premenopausal protection, delaying the development of coronary artery disease by 10 to 15 years in women.¹ Coronary artery disease is considered to be premature when it occurs before the age of 65 in women, in contrast to 55 in men. Because the average age of menopause has been 50 to 51 years for centuries, coronary artery disease in premenopausal women represents the most premature form of coronary artery disease and is extremely rare, except perhaps among Asian Indians.² For example, each year only 3000 women versus 123 000 men in the United States develop a myocardial infarction before the age of 45. This low incidence makes it difficult to identify the risk factors for coronary artery disease in premenopausal women. Therefore, I read with great interest the report by Orth-Gomér et al³ about the 5.1-fold higher risk of hospitalization for acute coronary artery disease in premenopausal women with serum lipoprotein(a) levels >30 mg/dL. The risk of coronary artery disease in Swedish women with elevated lipoprotein(a) is significantly higher than the 3-fold higher risk reported in middle-aged German men with similar elevation of lipoprotein(a) and is nearly equal to the 5.3-fold risk in men with lipoprotein(a) >70 mg/dL.⁴ Elevated serum levels of lipoprotein(a) have been associated with . . . [Full Text of this Article]

Kristina Orth-Gomér, MD, PhD

Division of Preventive Medicine, Karolinska Institutet, Huddinge, Sweden

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