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January 21, 2004

Novel Risk Factors for Atherosclerosis

Author Affiliations

Letters Section Editor: Stephen J. Lurie, MD, PhD, Senior Editor.

JAMA. 2004;291(3):301. doi:10.1001/jama.291.3.301-a

To the Editor: In their review article, Drs Hackam and Anand1 discussed the 4 novel risk factors of C-reactive protein, lipoprotein(a) [Lp(a)], fibrinogen, and homocysteine to predict atherosclerosis. The authors concluded that their optimal use remains to be determined.

Because of the high negative predictive value of classic risk factors2,3 there appears to be no need to screen for these novel risk factors as primary prevention. However, there is a need to improve risk estimation in groups of individuals with high and intermediate risk.4 In contrast to the conclusions of Hackam and Anand, we have reported that an Lp(a) level greater than 30 mg/dL (1.07 µmol/L) further increases the risk of men at intermediate and high estimated global risk.5

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