Letters Section Editor: Stephen J. Lurie,
MD, PhD, Senior Editor.
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
von Eckardstein A. Novel Risk Factors for Atherosclerosis. JAMA. 2004;291(3):301. doi:10.1001/jama.291.3.301-a