Recent Advances in Cardiovascular Risk Factors Edited by Mehnaz Atiq pptx

RECENT ADVANCES
IN CARDIOVASCULAR
RISK FACTORS

Edited by Mehnaz Atiq










Recent Advances in Cardiovascular Risk Factors
Edited by Mehnaz Atiq


Published by InTech
Janeza Trdine 9, 51000 Rijeka, Croatia

Copyright © 2012 InTech
All chapters are Open Access distributed under the Creative Commons Attribution 3.0
license, which allows users to download, copy and build upon published articles even for
commercial purposes, as long as the author and publisher are properly credited, which
ensures maximum dissemination and a wider impact of our publications. After this work
has been published by InTech, authors have the right to republish it, in whole or part, in
any publication of which they are the author, and to make other personal use of the
work. Any republication, referencing or personal use of the work must explicitly identify

the original source.

As for readers, this license allows users to download, copy and build upon published
chapters even for commercial purposes, as long as the author and publisher are properly
credited, which ensures maximum dissemination and a wider impact of our publications.

Notice
Statements and opinions expressed in the chapters are these of the individual contributors
and not necessarily those of the editors or publisher. No responsibility is accepted for the
accuracy of information contained in the published chapters. The publisher assumes no
responsibility for any damage or injury to persons or property arising out of the use of any
materials, instructions, methods or ideas contained in the book.

Publishing Process Manager Silvia Vlase
Technical Editor Teodora Smiljanic
Cover Designer InTech Design Team

First published March, 2012
Printed in Croatia

A free online edition of this book is available at www.intechopen.com
Additional hard copies can be obtained from


Recent Advances in Cardiovascular Risk Factors, Edited by Mehnaz Atiq
p. cm.
ISBN 978-953-51-0321-9

Contents

Preface IX
Chapter 1 Lipoprotein (a) and Cardiovascular Risk 1
José Antonio Díaz Peromingo
Chapter 2 Remnant Lipoproteins are a Stronger Risk Factor
for Cardiovascular Events than LDL-C – From
the Studies of Autopsies in Sudden Cardiac Death Cases 15
Katsuyuki Nakajima

and Masaki Q. Fujita
Chapter 3 Cardiovascular Risk Factors and Liver Transplantation 37
Anna Rossetto, Umberto Baccarani and Vittorio Bresadola
Chapter 4 Pathogenesis of Renovascular
Hypertension: Challenges and Controversies 49
Blake Fechtel, Stella Hartono and Joseph P. Grande
Chapter 5 Cardiovascular Disease in Inflammatory
Disorders – Psoriasis and Psoriatic Arthritis 67
Aizuri Murad and Anne-Marie Tobin
Chapter 6 Cardiovascular Risk Factors in Elderly
Normolipidaemic Acute Myocardial Infarct Patients 83
Arun Kumar
Chapter 7 Erectile Dysfunction Complicating
Cardiovascular Risk Factors and Disease 99
Irekpita Eshiobo, Emeka Kesieme and Taofik Salami

Chapter 8 Vascular Dysfunction in
Women with Recurrent Pregnancy Loss 123
Mikiya Nakastuka
Chapter 9 The Polycystic Ovary Syndrome Status –
A Risk Factor for Future Cardiovascular Disease 151
Ioana Ilie, Razvan Ilie, Lucian Mocan, Carmen Georgescu,
Ileana Duncea, Teodora Mocan, Steliana Ghibu and Cornel Iancu
VI Contents

Chapter 10 Premature Atherosclerosis
Long After Kawasaki Disease 201
Nobutaka Noto and Tomoo Okada
Chapter 11 Dysmetabolic Syndrome 219
Elvira Craiu, Lucia Cojocaru, Andrei Rusali,
Razvan Maxim and Irinel Parepa
Chapter 12 The Relationship Between AST/ALT Ratio
and Metabolic Syndrome in Han Young Adults
– AST/ALT Ratio and Metabolic Syndrome 247
Qiang Lu, Xiaoli Liu, Shuhua Liu,
Changshun Xie, Yali Liu and Chunming Ma
Chapter 13 On the Mechanism of Action of Prolylcarboxypeptidase 255
B. Shariat-Madar, M. Taherian and Z. Shariat-Madar
Chapter 14 Adolescent Obesity Predicts Cardiovascular Risk 275
Jarosław Derejczyk, Barbara Kłapcińska,
Ewa Sadowska-Krępa, Olga Stępień-Wyrobiec,
Elżbieta Kimsa and Katarzyna Kempa
Chapter 15 Peculiarities of Coronary Artery Disease in Athletes 291
Halna du Fretay Xavier, Akoudad Hafid,
Hamadou Ouceyni and Benhamer Hakim
Chapter 16 Blood Pressure Regulation During

Bathing: Is There a Cardiovascular Risk? 309
Takeshi Otsuki and Yasuko Okuda
Chapter 17 Sagittal Abdominal Diameter as
the Anthropometric Measure of Cardiovascular Risk 319
Edita Stokić, Biljana Srdić, Vladimir

Brtka
and Dragana Tomić-Naglić
Chapter 18 The Use of Reynolds Risk Score in Cardiovascular
Risk Assessment in Apparently Healthy Bosnian
Men and Women: Cross-Sectional Study 341
Asija Začiragić
Chapter 19 The Assessment of Prevalence of Hypertension as
Cardiovascular Risk Factors Among Adult Population 359
Aida Pilav
Chapter 20 Theoretical Identification of Behavioral Risk Factors
Among Multiple Risk Factors Causing Morning Onset
of Cardiac Events due to Circadian Variations 383
Fumiko Furukawa and Tatsuya Morimoto
Contents VII

Chapter 21 Health Related Quality of Life in Coronary Patients 399
María Dueñas, Alejandro Salazar,
Begoña Ojeda and Inmaculada Failde
Chapter 22 Anger, Hostility and Other Forms of Negative
Affect: Relation to Cardiovascular Disease 415
Marco A.A. Torquato Jr., Bruno P.F. de Souza,
Dan V. Iosifescu and Renerio Fraguas
Chapter 23 “Recognizing Hunger” – A Training to Abate
Insulin Resistance, Associated Subclinical

Inflammation and Cardiovascular Risks 437
Mario Ciampolini
Chapter 24 Effects of Dietary Fiber Intake
on Cardiovascular Risk Factors 459
Sara Arranz, Alex Medina-Remón,
Rosa M. Lamuela-Raventós and Ramón Estruch
Chapter 25 Mediterranean Diet and Gene-Mediterranean
Diet Interactions in Determining Intermediate
Cardiovascular Disease Phenotypes 489
Mercedes Sotos Prieto








Preface

Among the non-communicable diseases, cardiovascular disorders are the leading
cause of morbidity and mortality in both the developed and the developing countries.
The spectrum of risk factors is wide and their understanding is imperative to prevent
the first and recurrent episodes of myocardial infarction, stroke or peripheral vascular
disease which may prove fatal or disabling.
There is ample evidence from longitudinal studies to prove that cardiovascular
diseases are preventable. Individuals with low levels of risk factors generally have a
healthy lifestyle. Genetic factors have to be kept in mind when risk stratification is
done for cardiovascular diseases. Despite our knowledge of risk factors, huge
differences exist in the prevalence between populations within the same region,

between men and women and in the racial and ethnic subgroups. Much of this
variability is explained on the basis of behavioral and cultural differences rather than
genetic or clinical reason. Moreover, risk factors are frequently redefined as newer
research throws light on interventions and their results.
This book has tried to present an update on risk factors incorporating new research
which has thrown more light on the existing knowledge. It has also tried to highlight
regional diversity addressing such issues. It will hopefully be resourceful to the
cardiologists, general practitioners, family physicians, researchers, graduate students
committed to cardiovascular risk prevention.

Dr. Mehnaz Atiq
Division of Cardiac Services
Aga Khan University Hospital
Karachi, Pakistan


1
Lipoprotein (a) and Cardiovascular Risk
!"#$%&'("')"%*+,-%./0"1)'2"%
Short Stay Medical Unit, Department of Internal Medicine,
Hospital Clínico Universitario, Santiago de Compostela,
Spain
1. Introduction
3)0#(%/4)5/1)"6"2)7,6%#(85)/#%"9%:4;,<%,'5%=>*%?/0/%0/4"0(/5%,(%(@/%/'5%"9%(@/%6,#(%7/'(80A%
;BCD<% E8(% (@/% )'F/#()2,()"'% "9% (@)#% 6)4"40"(/)'% ,#% ,% 4"(/'(),6% 7,05)"F,#786,0% 0)#G% 9,7("0% @,#%
E//'%@,14/0/5%EA%(@/%6,7G%"9%7"'#)#(/'(%,440",7@/#%("%)(#%1/,#80/1/'(%9"0%5/7,5/#H%:4;,<%
6,E"0,("0A% #(,'5,05)-,()"'% /1/02/5% )'% IJJJ% ;K<% ,'5% ?,#% ,77/4(/5% EA% (@/% L"065% >/,6(@%
M02,')-,()"'% )'% IJJK% ;N<H% &'"(@/0% 7@,66/'2/% ,##"7),(/5% ("% )(#% 1/,#80/1/'(% )#% (@/% 9,7(% (@,(%
4"486,()"'% 5)99/0/'7/#% 7,'% ,6#"% 7"'(0)E8(/% ("%F,0),()"'%)'%:4;,<%#/081%7"'7/'(0,()"'%;O<H%
P)'7/%:4;,<%7@,0,7(/0)-,()"'Q%/F)5/'7/#%9,F"0)'2%)(#%,##"7),()"'%?)(@%7,05)"F,#786,0%0)#G%@,F/%

E//'%0/4"0(/5H%&(%(@/%#,1/%()1/Q%#(85)/#%,2,)'#(%(@)#%,##"7),()"'%@,F/%,6#"%E//'%48E6)#@/5%
6/,5)'2%("%#"1/%7"'98#)"'%0/2,05)'2%("%(@/%4"##)E6/%0"6/%"9%:4;,<%)'%7,05)"F,#786,0%5)#/,#/H%
R@/%6,#(%A/,0#%@,F/%76,0)9)/5%#"1/?@,(%(@)#%)##8/%,'5%/F)5/'7/#%"9%:4;,<%,#%,'%)'5/4/'5/'(%
7,05)"F,#786,0% 0)#G% 9,7("0% @,F/% E//'% 40"4"#/5% ;SCBD<H% P/F/0,6% G/A% 4")'(#% #87@% ,#% )(#%
@"1"6"2A%?)(@%46,#1)'"2/'Q%5)99/0/'7/#%,1"'2%(@/%,4";,<%)#"9"01#Q%2/'/()7%7"'#)5/0,()"'#%
,#% ?/66% ,#% #4/7),6% 7)0781#(,'7/#% #87@% ,#% (@/% 0/6,()"'#@)4% "9% :4;,<% ,'5% ,(0),6% 9)E0)66,()"'Q%
5),6A#)#Q%,67"@"6%7"'#814()"'%,'5%E6""5%7",286,()"'%@,F/%E//'%)'F/#()2,(/5H%T'%(@)#%7@,4(/0Q%
:4;,<% 1/(,E"6)#1Q% /4)5/1)"6"2)7,6% ,'5% 2/'/()7% 7"'#)5/0,()"'#Q% ,##"7),()"'% ?)(@% 7"0"',0A%
@/,0(% 5)#/,#/% ,'5% #(0"G/Q% #4/7),6% #)(8,()"'#% ,#% ?/66% ,#% 7"'(0"F/0#)/#% ,'5% 7800/'(% (0/,(1/'(%
"4()"'#%,0/%0/6,(/5H%%%%
2. Lipoprotein (a) metabolism
:)4"40"(/)'% ;,<Q% :4% ;,<Q% )#% ,% 6"?% 5/'#)(A% 6)4"40"(/)'% ;:*:<C6)G/% 4,0()76/% #A'(@/#)-/5% )'% (@/%
6)F/0%EA%@/4,("7A(/#%,'5%(@/'%#/70/(/5% )'("% 46,#1,H% T(% ?,#% 9)0#(%5/#70)E/5%EA% U/02% )'% BVOD%
;BK<H%T(%7"'#)#(#%"9%,'%,4"6)4"40"(/)'%UBJJ%;,4"UBJJ<%1"6/786/%(@,(%)#%6)'G/5%7"F,6/'(6A%EA%,%
5)#869)5/% E"'5% ("% ,% 6,02/% 26A7"40"(/)'% G'"?'% ,#% ,4"6)4"40"(/)'% ;,<Q% W,4";,<X% ;BN<H% :4;,<%
1/(,E"6)7%0"8(/%)#%#@"?'%)'%9)280/%BH%T(#%1"6/786,0%?/)2@(%0,'2/#%90"1%IJJ%G*,%("%1"0/%(@,'%
YJJ%G*,%;BO<H%R@/%,4";,<%2/'/%;LPA<%)#%,%1,Z"0%5/(/01)','(%"9%(@/%46,#1,%7"'7/'(0,()"'%"9%
:4;,<Q%)'7685)'2%F,0),()"'#% )'%(@/% G0)'26/%0/2)"'C7"5)'2%0/4/,(#Q%?)(@%,77"8'(#% 9"0%(@/% #)-/%
4"6A1"04@)#1% "9% ,4";,<% 6/,5)'2% ("% 5)99/0/'(% ,4";,<% #)-/#% ;BS<H% R@)#% 9,7(% )#% F/0A% )14"0(,'(%
E/7,8#/% #1,66% #)-/% )#"9"1#% #//1% ("% E/% ,##"7),(/5% ("% ?"0#/% 7,05)"F,#786,0% 40"9)6/H% &4";,<%
7@,)'%7"'(,)'#%N%7A#(/)'/C0)7@%5"1,)'#%G'"?'%,#%G0)'26/#Q%,'5%/#4/7),66A%[0)'26/%T\%;[T\<%)#%
F/0A%#)1)6,0%("%46,#1)'"2/'%;BYQBV<H%R@)#%4,0()76/%)#%'"(%"'6A%6"7,(/5%)'%(@/%46,#1,%E8(%,6#"%
@,#%E//'%#@"?'%("%/'(/0%(@/%,0(/0),6%)'()1,%"9%@81,'#%,'5%@,#%,'%)'70/,#/5%,99)')(A%EA%(@/%

Recent Advances in Cardiovascular Risk Factors

2
/](0,7/6686,0%1,(0)]%;IJ<H%R@)#%)##8/%7"'9/0#%,%20/,(/0%"44"0(8')(A%("%:4;,<%"])5,()"'%;IB<%,'5%
)'(/0,7()"'% "9% :4;,<% ?)(@% 1,70"4@,2/#% ;IIQID<H% ^/7/'(6AQ% )(% @,#% E//'% #822/#(/5% (@,(% :4;,<%
7"865% E/% ,% 40/9/0/'(),6% 7,00)/0% "9% "])5)-/5% 4@"#4@"6)4)5#% )'% @81,'% 46,#1,% ;IK<H% R@/#/%

"])5)-/5% :4;,<% @,F/% ,% 20/,(/0% ,(@/0"#76/0"()7% /99/7(% ,#% 7"14,0/5% ("% ',()F/% :4;,<% ,'5% (@)#%
,7()"'% 1,A% E/% )'70/,#/5% EA% @A4/02687/1),% ;IN<H% *)99/0/'(% :4;,<% #8E(A4/#% @,F/% E//'%
40"4"#/5%0/2,05)'2%("%,4";,<%)#"9"01#%,'5%(@/#/%,4";,<%)#"9"01#%40/5)7(%(@/%0)#G%9"0%=>*%
)'5/4/'5/'(6A% "9% (@/% /(@')7% 20"84% ;IO<H% R@/#/% )#"9"01#% ,0/% 76,##)9)/5% )'% "05/0% ("% (@/)0%
5)99/0/'(%#)-/% ;BO<H% R,E6/%B% #@"?#% 76,##)9)7,()"'%"9%(@/#/%)#"9"01#%,'5%)(#%0/6,()"'%?)(@%[T\%
0/4/,(#H%%%%%
LIVER
B100
LDL
Apo(a)
B100
Lp(a)
B100
Lp(a) oxidated
Macrophage
Cell
Oxidation
Receptor?
%
3)2H%BH%_/(,E"6)7%0"8(/%"9%:4;,<H%
3. Epidemiological aspects
.6,#1,% 6/F/6#% "9% :4;,<% #@"?% 20/,(% 5)F/0#)(A% 0/2,05)'2% ("% 5)99/0/'(% /(@')7,6% 20"84#% E8(% ,%
46,#1,()7% 7"'7/'(0,()"'% 20/,(/0% (@,'% DJ% 12`56% )#% 7800/'(6A% 7"'#)5/0/5% ,'% )'5/4/'5/'(%
7,05)"F,#786,0% 0)#G% 9,7("0% ;IS<H% T'% (@)#% #/'#/Q% &90)7,'C&1/0)7,'#% @,F/% @)2@/0% :4;,<%
7"'7/'(0,()"'#%(@,'%=,87,#),'#H%R@/#/%6/F/6#%1,A%,6#"%E/%F/0A%5)99/0/'(%/F/'%)'%)'5)F)58,6#%
7,00A)'2%,4";,<%"9%(@/%#,1/%#)-/%4"6A1"04@)#1H%T(%@,#%E//'%#822/#(/5%(@/%4"##)E)6)(A%"9%(@/%
40/#/'7/%"9%,55)()"',6%9,7("0#%,99/7()'2%(@)#%/(@')7,6%5)99/0/'7/#%"0%(@/%/])#(/'7/%"9%@)2@%0)#GC
:4;,<% "0% 6"?% 0)#GC:4;,<% ;IYQIV<H% UA% (@/% "(@/0% @,'5Q% '"(% ,66% /(@')7% 20"84#% #@"?% (@/% #,1/%
0/6,()"'%?)(@%:4;,<H%T'%&1/0)7,'CT'5),'#Q%:4;,<%6/F/6%@,#%E//'%0/4"0(/5%("%E/%6"?%,'5%'"'%
)'5/4/'5/'(6A%,##"7),(/5%?)(@%7,05)"F,#786,0%5)#/,#/%;DJ<H%%%%%

Lipoprotein (a) and Cardiovascular Risk

3
>700 >25
500-650 20-25
400-50013-20
<400 5-12
Molecular weight (kDa)Repeats (No.)
%
R,E6/%BH%^/6,()"'%E/(?//'%[T\
I%
%0/4/,(#%,'5%,4";,<%)#"9"01#%#)-/%
^/#4/7()'2%("%,4";,<%)#"9"1#Q%)(%@,#%E//'%#822/#(/5%,%1"#(%)14"0(,'(%4,(@"2/')7%0"6/%"9%:4;,<%
4,0()76/#%?)(@%#1,66/0%,4";,<%)#"9"01#%;BYQDB<H%R@)#%)#%40"E,E6A%58/%("%#/F/0,6%9,7("0#H%3)0#(Q%,'%
)'70/,#/5% 7,4,7)(A% ("% E)'5% "])5)-/5% 4@"#4@"6)4)5#Q% #/7"'5Q% (@/% ,E)6)(A% ("% 6"7,6)-/% )'% E6""5%
F/##/6% ?,66#Q% ,'5% /F/'(8,66A% 0/6,(/5% ("% )(#% (@0"1E"2/')7% /99/7(% EA% )'70/,#)'2% )'@)E)()"'% "9%
46,#1)'%,7()F)(AH%&4";,<%#)-/%@/(/0"2/'/)(A%)#%0/6,(/5%("%,%7"4A%'81E/0%F,0),()"'%)'%(@/%40"(/)'%
5"1,)'%G0)'26/%T\%(A4/%I%;[T\
I
<% ;DI<% ;R,E6/% B<H% R@)#%7"4A% '81E/0% F,0),()"'% ;NCNJ% )5/'()7,66A%
0/4/,(/5%7"4)/#<% 7"'9/0#% @/(/0"2/'/)(A%)'%(@/%1"6/786,0% 1,##% "9%,4";,<% 0,'2)'2% E/(?//'% IJJ%
,'5%YJJ%G*,H%a(@')7,6%5)99/0/'7/#%)'%(@/%90/b8/'7A%5)#(0)E8()"'%"9%,4";,<%[T\%0/4/,(/5%,66/6/#%
@,F/%E//'% 0/4"0(/5% ;DDQDK<H%T'%,66%/(@')7% 20"84#Q% =,87,#),'#Q% &#),'#%,'5% &90)7,'C&1/0)7,'#Q%
@)2@/0% 6/F/6#% "9% 7)0786,()'2% :4;,<% 7"'7/'(0,()"'#%(/'5%("%E/%,##"7),(/5%?)(@%#1,66/0%,4";,<%
)#"9"01#%;DNQDO<H%R@)#%9)'5)'2%7"865%/]46,)'%4,0(),66A%(@/%,##"7),()"'%"9%@)2@/0%:4;,<%6/F/6#%,'5%
7,05)"F,#786,0% 5)#/,#/H% ./"46/% ?)(@% #1,66/0% ,4";,<% )#"9"01#% @,F/% ,'% ,440"])1,(/6A% IC9"65%
@)2@/0% 0)#G% "9% 7"0"',0A% ,0(/0A% 5)#/,#/% ,'5% )#7@/1)7% #(0"G/% (@,'% (@"#/% ?)(@% 6,02/0% ,4";,<%
)#"9"01#H%380(@/01"0/Q%)#"9"01#%?)(@%6/##%[T\%0/4/()()"'#%;)#"9"01#%3Q%UQ%PB%,'5%PI<%@,F/%(@/%
20/,(/0%,',6"2A%?)(@%46,#1)'"2/'%E/)'2%,##"7),(/5%?)(@%@)2@/0%7"0"',0A%0)#G%;DSQDY<H%%%%%%%

4. Genetic considerations
&4";,<%2/'% ;ObIHOCbIHS<% ;DVQKJ<%@,F/%5)99/0/'(% G0)'26/% 5"1,)'#% (@,(%#@"?%,% @)2@% 5/20//% "9%
@"1"6"2A%("%(@/%G0)'26/%5"1,)'#%T\%,'5%\%"9%46,#1)'"2/'%;KB<H%
c/'/()7%F,0),'(#%,##"7),(/5%?)(@%:4;,<%6/F/6%@,F/%E//'%,##"7),(/5%?)(@%7"0"',0A%5)#/,#/%;KI<H%
_"0/%#4/7)9)7,66AQ%(@/%,4";,<%2/'%)#%(@/%1,Z"0%5/(/01)','(%"9%F,0),()"'%)'%#"1/%4"486,()"'#%
6)G/% &90)7,'C&1/0)7,'#% 1"586,()'2% (@/% 46,#1,()7% %7"'7/'(0,()"'%"9%:4;,<%;KD<H%T(%@,#%E//'%
0/4"0(/5%(@,(%,4";,<%2/'/%,77"8'(#%9"0%20/,(/0%(@,'%VJd%"9%(@/%F,0),()"'%"9%46,#1,()7%:4;,<%
7"'7/'(0,()"'#%;IY<H% &4";,<%2/'%4"6A1"04@)#"1#%,#%?/66%7/0(,)'%2/'/%768#(/0%,##"7),(/5%("%
LPA%@,F/%E//'%#@"?'%("%1"586,(/%:4;,<%7"'7/'(0,()"'#%6/,5)'2%("%,'%)'70/,#/%)'%(@/%0)#G%9"0%
7"0"',0A% ,0(/0A% 5)#/,#/% ;KK<H% R@/% 2/'/()7% E,#)#% 9"0% ,4";,<% )#"9"01% F,0),()"'% )#% ,% #/21/'(%
/])#()'2%)'%186()46/%0/4/,(#%;[T\
I
%4"6A1"04@)#1<%6"7,(/5%)'%(@/ LPA%2/'/%;KB<H%\,0),()"'#%)'%
'876/"()5/%4"6A1"04@)#1#%)'%LPA%1,A% E/%,'%)14"0(,'(% 7"'(0)E8("0%("%(@/%"E#/0F/5%:4;,<%
E/(?//'C4"486,()"'% F,0),'7/% ,'5% )'70/,#/% :4;,<% 6/F/6% )'% #"1/% 4"486,()"'#% ;KNCKS<H% M'7/%
,2,)'Q% /(@')7,6% 5)99/0/'7/#% @,F/% E//'% 0/4"0(/5% )'% 4/"46/% "9% a80"4/,'% 7"'()'/'(,6% ,'7/#(0A%
?@/0/%,4";,<%)#"9"01%4"6A1"04@)#1%7"'(0)E8(/#%E/(?//'%KJd%,'5%SJd%"9%(@/%F,0),()"'%"9%
:4;,<%7"'7/'(0,()"'%#@"?)'2%9/?/0%'81E/0%"9%[T\
I
%0/4/,(#%;KBQKO<Q%;R,E6/%B<H%%%%%

Recent Advances in Cardiovascular Risk Factors

4
5. Evidences favoring association with cardiovascular disease
C Coronary heart disease: =)0786,()'2% :4;,<% 7"'7/'(0,()"'% )#% ,##"7),(/5% ?)(@% 0)#G% "9%
7"0"',0A% @/,0(% 5)#/,#/% ;=>*<% )'5/4/'5/'(6A% 90"1% "(@/0% 7"'F/'()"',6% 0)#G% 9,7("0#%
)'7685)'2% ("(,6% 7@"6/#(/0"6% 7"'7/'(0,()"'H%:4;,<%/]7/##%@,#%E//'%)'5/4/'5/'(6A%
,##"7),(/5%("%1A"7,05),6%)'9,07()"'%,'5%8'#(,E6/%,'2)',%;KY<Q%0/#(/'"#)#%,9(/0%7"0"',0A%
,'2)"46,#(A% ;KV<Q% ,'5% 7"0"',0A% EA4,##% 20,9()'2% ;NJ<% 0/#4/7()F/6AH% .0"#4/7()F/%

/4)5/1)"6"2)7,6% #(85)/#% @,F/% 0/4"0(/5% 4"#)()F/% ,##"7),()"'% "9% E,#/6)'/% :4;,<%
7"'7/'(0,()"'%?)(@%=>*%0)#G%H%U,#/5%"'%(@)#%/4)5/1)"6"2)7,6%5,(,Q%,%0/6,()F/%0)#G%"0%BHN%
@,#% E//'% 0/4"0(/5% )'F"6F)'2% (@"#/% 4,()/'(#% ?)(@% 1/,'% :4;,<% F,68/#% "9% NJ% 12`5:Q%
/#4/7),66A%)'%4,()/'(#%?)(@%40/1,(80/%7"0"',0A%5)#/,#/%;NB<H%="'()'8"8#%,##"7),()"'#%"9%
:4;,<%?)(@%(@/%0)#G%"9%7"0"',0A%,0(/0A%%5)#/,#/%@,F/%E//'%0/4"0(/5%,'5%(@)#%,##"7),()"'%)#%
#)1)6,0% 0/2,05)'2% ("% 7"0"',0A% 5/,(@% ,'5%'"'C9,(,6% 1A"7,05),6% )'9,07()"'% ;NICNK<H% R@)#%
,##"7),()"'% )#% '"(% #)2')9)7,'(6A% ,99/7(/5% EA% #/]Q% '"'C>*:% "0% >*:% 7@"6/#(/0"6Q%
(0)26A7/0)5/#Q%E6""5%40/##80/Q%5),E/(/#Q%"9%E"5A%1,##%)'5/]H%R@/#/%0/#86(#%,0/%7"'#)#(/'(%
1,)'6A%)'%=,87,#),'#%E8(%#(85)/#%)'%'"'C=,87,#),'#%,0/%'//5/5%("%7"00"E"0,(/%,6#"%(@)#%
)##8/% )'% "(@/0% 4"486,()"'#% ;DD<H% R@/% ,##"7),()"'% "9% :4;,<% 7"'7/'(0,()"'#% ?)(@% =>*% )#%
"'6A%#6)2@(6A%0/587/5%,9(/0%,5Z8#(1/'(%9"0%6"'2C(/01%,F/0,2/%6/F/6#%"9%6)4)5#%,'5%"(@/0%
/#(,E6)#@/5% 0)#G% 9,7("0#H% R@)#% #)(8,()"'% )'70/,#/#% (@/% 6)G/6)@""5% (@,(% :4;,<% )#% ,'%
)'5/4/'5/'(%0)#G%9,7("0%9"0%=>*%;ND<H%R@/%#(0/'2(@%"9% :4;,<% ,#% 7"0"',0A% 0)#G% 9,7("0% )#%
0/6,()F/6A% 1"5/#(% ,#% 7"14,0/5% ?)(@% '"'C>*:% 7@"6/#(/0"6H% R@)#% )#% #"1/?@,(% 5)99/0/'(%
?@/'%(@/%6/F/6%"9%:4;,<%)#%F/0A%@)2@%6/,5)'2%("%,%40"4"0()"',66A%1"#(%)14"0(,'(%0"6/%9"0%
:4;,<%,#%=>*%0)#G%9,7("0%;NI<H%R0A)'2%("%,##"7),(/%9)E0)'"6A#)#%,'5%1A"7,05),6%)#7@/1)7%
5)#/,#/Q% )(% @,#% E//'% #822/#(/5% (@,(% :4;,<% 1,A% )'@)E)(% 9)E0)'"6A#)#% "9% 7"0"',0A% ,0(/0A%
(@0"1E8#%;NN<H%R@)#%)#%E/7,8#/%@)2@/0%6/F/6#%"9%:4;,<%@,F/%E//'%0/4"0(/5%)'%#80F)F"0#%"9%
1A"7,05),6%)'9,07()"'%)'%?@"1%0/7,',6)-,()"'%"9%)'9,07(%,0(/0A%9,)6/5%,#%7"14,0/5%?)(@%
4,()/'(#% ?)(@% ,% 4,(/'(% ,0(/0A% ;NO<H% M(@/0% 40"#4/7()F/% #(85)/#% @,F/% '"(% #@"?'%
0/6,()"'#@)4%E/(?//'%@)2@%6/F/6#%"9%:4;,<%"0%,4";,<%)#"9"01#%,'5%7,05)"F,#786,0%0)#G%;NSC
NV<%7"'(0)E8()'2%("%#"1/%5/20//%"9%7"'(0"F/0#AH%%%%%
C Stroke: P/081% :4;,<% 7"'7/'(0,()"'% )#% ,6#"% ,##"7),(/5% )'5/4/'5/'(6A% ?)(@% 0)#G% "9%
)#7@/1)7%#(0"G/%;OJQOB<H%=800/'(%5,(,%)'% 0/6,()"'% ("% :4;,<% 7"'7/'(0,()"'%,'5%#(0"G/%,0/%
#4,0#/%E8(%#//1%("%E/%#)1)6,0%(@,'%(@"#/%9"0%=>*H%P/081%:4;,<%6/F/6%?,#%5/1"'#(0,(/5%
("% 40/5)7(% #(0"G/% )'% /65/06A% 4/"46/% )'% ,% 6,02/% 6"'2)(85)',6% ;OI<% ,'5% )'% ,% 7,#/C7"'(0"6%
#(85A% ;OD<H% T(% @,#% E//'% #@"?'% (@,(% @)2@% 6/F/6#% "9% :4;,<% ,0/% ,##"7),(/5% ?)(@% )#7@/1)7%
#(0"G/%)'%4,()/'(#%?)(@%,(0),6%9)E0)66,()"'%/#4/7),66A%?@/'%6/9(%,(0),6%(@0"1E8#%)#%40/#/'(%
;OK<H% e'@/,6(@A% 5)/(,0A% 9,(% )'(,G/% ,'5% ,% @)2@% #/081% :4;,<% 6/F/6% @,F/% E//'% #@"?'% ("%
40/5)7(% 9,(,6% ,'5% '"'9,(,6% #(0"G/% "9% (0,'#)/'(% )#7@/1)7% ,((,7G% )'5/4/'5/'(6A% "9%

/#(,E6)#@/5% 0)#G% 9,7("0#% )'% ,% #(85A% "9% ,% 7"118')(ACE,#/5% #,146/% "9% 1)556/C,2/% 1/'%
;ON<H% :4;,<% @,#% ,6#"% E//'% 5/(/7(/5% )'% )'(0,4,0/'7@A1,6% 7/0/E0,6%F/##/6#%#822/#()'2%,%
4"(/'(),6%)196,11,("0A%0"6/%)'%,78(/%#(0"G/%9"0%:4;,<%;OO<H%M(@/0%#(85)/#%@,F/%'"(%9"8'5%
#(,()#()7,6%0/6,()"'#@)4%E/(?//'%@)2@/0%6/F/6%"9%:4;,<%,'5%(@0"1E"()7%#(0"G/%;OS<H%%
6. Special situations
R@/0/%,0/% #"1/% 7"11"'%1/5)7,6%7"'5)()"'#% (@,(%1,A%E/% )'968/'7/5%EA%(@/% 6/F/6% "9% :4;,<H%
="'F/0#/6AQ%#/081%:4;,<%6/F/6#%7,'%E/%1"5)9)/5%EA%(@/%/])#(/'7/%"9%#"1/%1/5)7,6%5)#"05/0#H%
R@/#/%1/5)7,6%7"'5)()"'#%,0/%#811,0)-/5%,#%9"66"?#f%

Lipoprotein (a) and Cardiovascular Risk

5
C Lp(a) and dialysis:% T(% )#% ?/66% G'"?'% (@,'% ,(@/0"#76/0"#)#% )#% 1"0/% 40/F,6/'(% ,1"'2%
4,()/'(#%?)(@%/'5C#(,2/%0/',6% 5)#/,#/% ;OY<H% >/1"5),6A#)#%40"7/580/%g4/0% #/h% @,#% E//'%
#@"?'%("% 1"5)9A%#/081%6/F/6#% "9% :4;,<%)'70/,#)'2%(@/1%,9(/0%@/1"5),6A#)#%40"7/580/%
;OV<H% T(% @,#% E//'% 40"4"#/5% (@,(% )'96,11,()"'Q% ,% F/0A% )14"0(,'(% 7"'5)()"'% )'%
@/1"5),6A#)#%4,()/'(#Q%7"865%46,A%,'%)14"0(,'(%0"6/%)'%(@)#%:4;,<%)'70/,#/%;SJCSI<H%U,#,6%
#/081% 6/F/6#% "9% :4;,<% ,0/% )'70/,#/5% )'% 5),6A#)#% 4,()/'(#% ,'5% (@/% 6/F/6% )#% /6/F,(/5% )'%
,61"#(% SJd% "9% 4,()/'(#% ;SD<H% aF/'% 1"0/Q% )'% 4,()/'(#% ?)(@% 7"'()'8"8#% ,1E86,("0A%
4/0)("'/,6% 5),6A#)#Q% :4;,<% 6/F/6% )#% #)2')9)7,'(6A% @)2@/0% ,#% 7"14,0/5% ?)(@% 4,()/'(#% "'%
@/1"5),6A#)#%;SK<%4")'()'2%("%,%4"##)E6/%1"586,()'2%/99/7(%"9%:4;,<%7"'7/'(0,()"'%EA%(@/%
5)99/0/'(% 5),6A#)#% 40"7/580/#H% .,0()786,06AQ% @)2@% #/081% :4;,<% 6/F/6#% ,'5% (@/% 6"?%
1"6/786,0% ?/)2@(% ,4";,<% 4@/'"(A4/% @,F/% E//'% ,##"7),(/5% ?)(@% ,5F/0#/% 76)')7,6%
"8(7"1/#%)'%5),6A#)#%4,()/'(#%;SN<H%%
C Lp(a) and atrial fibrillation: >)2@/0% #/081% :4;,<% 6/F/6% )'% )#7@/1)7% #(0"G/% 4,()/'(#%
,##"7),(/5% ?)(@% ,(0),6% 9)E0)66,()"'% ,'5% 6/9(% ,(0),6% (@0"1E8#% 9"01,()"'% "0% )'% ,78(/%
1A"7,05),6%)'9,07()"'%@,#%E//'%0/4"0(/5%;SOQSS<H%:4;,<%/6/F,()"'%,'5%0/587/5%6/9(%,(0),6%
,44/'5,2/% 96"?% F/6"7)()/#% @,F/% E//'% #@"?'% ("% E/% )'5/4/'5/'(6A% 0)#G% 9,7("0#% 9"0%
(@0"1E"/1E"6)#1% )'% 7@0"')7% '"'F,6F86,0% ,(0),6% 9)E0)66,()"'% ;NN<H% .0"E,E6AQ% (@/%
,##"7),()"'% "9% :4;,<% )#% #(0"'2/0% )'% (@/% 40/#/'7/% "9% ,(0),6% (@0"1E8#% )'#(/,5% "9% ,(0),6%

9)E0)66,()"'% )(#/69Q% E/7,8#/% "9% (@/% 46,#1)'"2/'% )'@)E)("0A% ,7()"'% "9% :4;,<% ;OK<H% T'% (@)#%
#/'#/Q%"(@/0%#(85)/#%@,F/%'"(%9"8'5%,##"7),()"'%E/(?//'%@)2@/0%6/F/6#%"9%:4;,<%,'5%'"'C
F,6F86,0%,(0),6%9)E0)66,()"'%;SY<H%%%
C Lp(a) and blood coagulation:%(@/%2/'/()7%@"1"6"2A%)'%(@/%7*i&%#/b8/'7/%"9%@81,'%
,4";,<% ?)(@% 46,#1)'"2/'Q% (@/% -A1"2/'% 9"0% (@/% 1,Z"0% 9)E0)'"6A()7% #/0)'/% 40"(/,#/%
46,#1)'%;SV<Q%@,#%E//'%0/6,(/5%?)(@%(@/%7,05)"F,#786,0%4,(@"2/')7)(A%"9%:4;,<%;YJ<H%R@/0/%
)#%,%1,Z"0%5)99/0/'7/%)'%(@/%G0)'26/%#(087(80/%E/(?//'%46,#1)'"2/'%,'5%:4;,<%(@,(%)#%,%
#)'26/%,1)'",7)5%/]7@,'2/%;^NOJP<%(@,(%40/F/'(#%,4";,<%90"1%/'-A1,()7%76/,F/,2/%#87@%
,#% (@/% ,7()"'% "9% ()##8/C(A4/% 46,#1)'"2/'% ,7()F,("0% ;(C.&<%"0%80"G)',#/%46,#1)'"2/'%
,7()F,("0%;8C.&<H%R@)#%1"6/786,0%1)1)70A%E/(?//'%46,#1)'"2/'%,'5%:4;,<%7"'(0)E8(/%("%
(@/%0"6/%"9% :4;,<% )'% ,(@/0"2/'/#)#%E)'5)'2%:4;,<% ("%(@/%()##8/% 9,7("0% 4,(@?,A%)'@)E)("0%
;R3.T<Q%5"7G)'2%("%5)F/0#/%6)4"40"(/)'%0/7/4("0#%;/#4/7),66A%(@"#/%,99/7()'2%:*:%"0%F/0A%
6"?% 5/'#)(A% 6)4"40"(/)'% ;\:*:<% ,'5% EA% (@/% /'(0,41/'(% "9% :4;,<% )'("% 1,(0)7/6686,0%
40"(/)'#%;YB<H%R@)#%#)(8,()"'%6/,5#%("%,%0/(/'()"'%"9%:4;,<%,'5%0/708)(1/'(%"9%1"'"7A(/#Q%
840/286,()'2%(@/%/]40/##)"'%"9%(@/%46,#1)'"2/'%,7()F,("0%)'@)E)("0%I%)'%(@/#/%1"'"7A(/#%
;YI<H%T(%@,#%,6#"%E//'%0/4"0(/5%(@,(%:4;,<%1"586,(/#%/'5"(@/6),6%7/66%#809,7/%9)E0)'"6A#)#%
7"'(0)E8()'2%("%(@/%)'70/,#/%)'%,(@/0"#76/0"()7%0)#G%;YD<H%
C Lp(a) and alcohol intake: _,'A%/4)5/1)"6"2)7,6%,'5% 76)')7,6%#(85)/#%@,F/%#@"?'%(@,(%
6)2@(C("C1"5/0,(/% ,67"@"6% 7"'#814()"'% )#% ,##"7),(/5% ?)(@% 0/587/5% 0)#G% "9% =>*% ,'5%
("(,6% 1"0(,6)(A% )'% (@/% 1)556/C,2/% ,'5% /65/06A% "9%E"(@% 2/'5/0#% ;YKQYN<H% :)4)5% 6/F/6#% ,0/%
1"5)9)/5%EA%,67"@"6%)'%5)99/0/'(%9"01#%E8(%)(%)#%'"(%7"146/(/6A%76/,0%(@/%?,A%(@/A%,0/H%T'%
,67"@"6%,E8#/%4,()/'(#Q%6/F/6#%"9%:4;,<%@,F/%E//'%0/4"0(/5%("%5/70/,#/%,'5%(@)#%@,#%E//'%
0/6,(/5% ("% (@/% ()1/% "9% ,E#()'/'7/% ;YO<H% T'%"(@/0%#(85A%,'%)'70/,#/5%6/F/6%,1"'2%(,E6/%
?)'/%50)'G/0#%@,#%E//'%5/#70)E/5%;YS<H%&%#4/7),6%#)(8,()"'%)#%(@/%,##"7),()"'%"9%,67"@"6%
)'(,G/Q%:4;,<%6/F/6%,'5%F,#786,0%5)#/,#/H%T'%(@)#%#/'#/Q%@)2@%#/081%:4;,<%7"'7/'(0,()"'%
,'5%@/,FA%50)'G)'2%?/0/%9"8'5%)'5/4/'5/'(6A%,##"7),(/5%?)(@%6,02/0%)'90,0/',6%,"0()7%
5),1/(/0#%;YY<%,'5%,E5"1)',6%,"0()7%,'/80A#1#%;YV<Q%40"E,E6A%58/%("%(@/%7,4,E)6)(A%"9%
:4;,<%("%)'@)E)(%/6,#("6A#)#%)'%(@/%F/##/6#%?,66%;VJ<H%%

Recent Advances in Cardiovascular Risk Factors

6
7. Treatment
R0/,(1/'(% 4"##)E)6)()/#% ,0/% #7,07/% ,(% 40/#/'(% ?@/'% (@/% ,)1% )#% ("% 0/587/% :4;,<% 46,#1,%
7"'7/'(0,()"'H%M'6A%'),7)'Q%)'%,%5"#/%5/4/'5/'(%9,#@)"'Q%,'5%7/0(,)'%)'@)E)("0#%"9%7@"6/#(/0A6%
/#(/0% (0,'#9/0% 40"(/)'% @,F/% #@"?'% 6)1)(/5% /99/7(% 0,'2)'2% E/(?//'% IJdCKJd% 6"?/0)'2% 90"1%
E,#/6)'/%6/F/6#%;VBQVI<H%M(@/0%5082#%#87@%,#%,7/(A6#,6)7A6)7%,7)5%,'5%:C7,0')()'/%7,'%5/70/,#/%
1)656A%/6/F,(/5%:4;,<%7"'7/'(0,()"'#%;VBQVDQVK<H%="'(0,5)7("0A%9)'5)'2#%@,F/%E//'%0/4"0(/5%
?)(@% #(,()'#% ;VNCVY<H% .0"1)#)'2% 1"6/786/#% 6)G/% 1)4"1/0#/'Q% ,'% ,'()#/'#/% "6)2"'876/"()5/%
5)0/7(/5% ("% @81,'% ,4"U
BJJ
%@,F/%E//'%#@"?'%("%0/587/%:4;,<% 7"'7/'(0,()"'#% EA% SJd% )'%
(0,'#2/')7% 1)7/% ;VV<H% P)1)6,0% 1"6/786/#% #87@%,#%/40"()0"'/Q%()E"6"'/%,'5%40"40"(/)'%
7"'F/0(,#/% #8E()6)#)'`G/])'% (A4/% V% ;.=P[CV<% )'@)E)("0#% 7,'% ,6#"% 5/70/,#/% :4;,<%
7"'7/'(0,()"'#% E/)'2% 7800/'(6A% 8'5/0% 5/F/6"41/'(% ;VBQBJJCBJI<H% i/F/0(@/6/##Q% (@/% 1"#(%
50,1,()7% 7@,'2/% )'% :4;,<% 7"'7/'(0,()"'#% 7,'% E/% ,7@)/F/5% ?)(@% 0/286,0% 6)4)5% ,4@/0/#)#%
;BJDQBJK<H% R,E6/% I% #@"?#% (@/% /99)7,7A% "9% 5)99/0/'(% (0/,(1/'(% "4()"'#% )'% 0/587)'2% :4;,<%
46,#1,()7%6/F/6H%%
40-60Apheresis
15-40Estrogen substitutive
therapy
25Neomicine
35Nicotinic acid
5Statins
5-10 Fibrates
0Resins
0Diet and exercise
Change in Lp(a)
concentration (%)
Treatment

%
R,E6/%IH%a99/7(%"9%5)99/0/'(%4@,01,7"6"2)7,6%(@/0,4)/#%"'%:4;,<%#/081%7"'7/'(0,()"'H%
8. Controversies
R@/%0)#G%,##"7),(/5%("%:4;,<%7"'7/'(0,()"'%)#%"'6A%,E"8(%"'/Cb8,0(/0%"9%(@,(%#//'%?)(@%:*:%
7@"6/#(/0"6% #"% ,'A% 76)')7,6% )146)7,()"'% "9% (@)#% 1"5/0,(/% ,##"7),()"'% 7800/'(6A% ,44/,0/5%
6)1)(/5H% R@/% 0"6/% "9% #4/7)9)7% :4;,<% #8E(A4/#% 7"865% @/64% ("% 76,0)9A% (@/% F,#786,0% 0)#GH%
.,0()786,06AQ%#1,66/0%,4";,<%)#"9"01#%7"865%,7(%,##"7),(/5%?)(@%"(@/0%9,7("0#%#87@%,#% #1,66C
5/'#/% :*:% ,'5% "])5)-/5% :*:% 4,0()76/#% )'% (@/% F/##/6% ?,66% )'70/,#)'2% )'96,11,()"'% ,'5%
,77/6/0,()'2%,(@/0"#76/0"()7%5)#/,#/H%R@)#%9,7(%'//5#%9"0%1"0/%)'F/#()2,()"'H%%
P(85)/#% 0/4"0()'2% ,##"7),()"'% "9% ,4";,<% )#"9"01#%#)-/%F,0),()"'#%?)(@%(@/%0)#G%"9%F,#786,0%
5)#/,#/% @,F/% 0/4"0(/5% 5)F/02/'(% 0/6,()F/% 0)#G#Q% )'F"6F/% ?)5/% 7"'9)5/'7/% )'(/0F,6#% ,'5% (@/%
'81E/0%"9%)'5)F)58,6#%)'7685/5%@,#% E//'%#1,66H%T9%#1,66/0%,4";,<%)#"9"01#%,0/%0/6/F,'(%("%

Lipoprotein (a) and Cardiovascular Risk

7
F,#786,0% 5)#/,#/% )'5/4/'5/'(% 90"1% :4;,<% 7"'7/'(0,()"'% )#% '"(% 7"146/(/6A% 76/,0% ,(% 40/#/'(H%
_"0/"F/0Q%1,'A%#(85)/#%@,F/%8#/5%5)99/0/'(%78(C"99#%("%5/9)'/%#1,66/0%,4";,<%#)-/H%
R@/% /99/7(% "9% (@/% 7@,'2/% )'% :4;,<% 6/F/6% ,'5% )(#% 0/6,()"'% ?)(@% )'96,11,()"'% ,#% ?/66% % ,#% )(#%
)'968/'7/%"'%/'5"(@/6),6%98'7()"'%,0/%8'G'"?'%,(%40/#/'(H%%
T(%@,#%E//'%#822/#(/5%(@,(%:4;,<%)#%,##"7),(/5%?)(@%=>*%"'6A%,(%F/0A%@)2@%7"'7/'(0,()"'#%E8(%
(@)#%,99)01,()"'%0/1,)'#%#"1/?@,(%7"'(0"F/0#),6%1,G)'2%F/0A%)14"0(,'(%("%)5/'()9A%4"##)E6/%
/(@')7,6%5)99/0/'7/#%,#%?/66%,#%,'%,5/b8,(/%78(C"99%6/F/6%?/%7,'%0/6A%"'H%%
9. Conclusions
:4;,<% 0/#86(#% 90"1% (@/% ,##"7),()"'% "9% ,4";,<% ,'5% :*:% 4,0()76/#H% P)'7/% 9)0#(% #(85)/#% 6)'G)'2%
:4;,<%,'5%7,05)"F,#786,0%5)#/,#/Q%,'%)14"0(,'(%,1"8'(%"9%76)')7,6%,'5%6,E"0,("0A%/F)5/'7/#%
@,F/%#844"0(/5%(@/%9,7(%(@,(%:4;,<%)#%,'5%)'5/4/'5/'(%7,05)"F,#786,0%0)#G%9,7("0Q%/#4/7),66A%
)'%A"8'2/0%4/"46/%?)(@%40/1,(80/%7,05)"F,#786,0%5)#/,#/H%%
_,'A%/(@')7,6%5)99/0/'7/#%,'5%F,0),()"'#%)'%,4";,<%#)-/%@,F/%E//'%0/4"0(/5H%_"0/"F/0Q%#1,66%
,4";,<% #)-/% )#"9"01#% @,F/% E//'% 0/6,(/5% ?)(@% ,'% )'70/,#/5% 7,05)"F,#786,0% 0)#GH% T(#% 0/6,()"'%

?)(@% (@/% '81E/0% "9% [T\% 0/4/,(#% 5/(/01)'/#% 2/'/()7,66A% F,0),()"'% )'% ,4";,<% #)-/H% P/F/0,6%
#(85)/#%)'7685)'2%1/(@,',6A#)#%@,F/%0/6,(/5%@)2@/0%6/F/6#%"9%:4;,<%?)(@%=>*%,'5%#(0"G/H%%
T(% #//1#% ,6#"% (@,(% :4;,<% )#% /6/F,(/5% )'% 4,()/'(#% 8'5/0% 5),6A#)#Q% ,'5% 4"##)E6A% )'% (@"#/% ?)(@%
,(0),6%9)E0)66,()"'%)'70/,#)'2%(@/%7,05)"F,#786,0%0)#G%"9%(@/#/%4,()/'(#Q%'"01,66A%,60/,5A%@)2@H%%%%
&'%)'(/0/#()'2%6)'G%E/(?//'%6,E"0,("0A%,'5%76)')7,6%/99/7(#%"9%:4;,<%)#%)(#%,7()"'%1"586,()'2%
(@/%9)E0)'"6A()7%#A#(/1%E/7,8#/%"9%(@/%20/,(%@"1"6"2A%E/(?//'%:4;,<%,'5%46,#1)'"2/'H%%
R@/% ,##"7),()"'% E/(?//'% @)2@/0% 6/F/6#% "9% :4;,<% ,'5% ,67"@"6% )'(,G/% 0/1,)'#% 1"0/%
7"'(0"F/0#),6%,(%40/#/'(H%%
=800/'(% (0/,(1/'(% "4()"'#% ,0/% '"(% F/0A% 8#/986% /]7/4(% 9"0% '),7)'% ,'5% 46,#1,% ,4@/0/#)#% E8(%
E"(@%(@/0,4)/#%,0/%'"(%/,#A%("%8#/%E/7,8#/%"9%("])7)(AQ%("6/0,E)6)(A%,'5%,F,)6,E)6)(AH%%
3)',66AQ% 6,02/% 40"#4/7()F/% #(85)/#% ,0/% '//5/5% 9"78#)'2% "'% :4;,<C,##"7),(/5% #1,66% ,4";,<%
)#"9"01#%,'5%7,05)"F,#786,0%5)#/,#/Q%,'5%,6#"%)'%"05/0%("%/'#80/%(0/,(1/'(%,440",7@/#H%%
10. References
WBX%P7@0)/?/0%>Q% &##1,''%cQ%P,'5G,14%_Q%P7@86(/%>H%R@/% 0/6,()"'#@)4% "9% 6)4"40"(/)'% ;,<%
;:4;,<<% ("% 0)#G% 9,7("0#% "9% 7"0"',0A% @/,0(% 5)#/,#/f% )')(),6% 0/#86(#% "9% (@/% 40"#4/7()F/%
/4)5/1)"6"2)7,6% #(85A% "'% 7"14,'A% /146"A//#% )'% L/#(9,6),H% !% =6)'% =@/1% =6)'%
U)"7@/1H%BVYKjIIfNVBCNVOH%
WIX%P7@/0'(@,'/0%cQ%["#('/0%c_Q%*)/46)'2/0%>Q%.0,2/0%^Q%_k@6@,8#/0%TH%&4"6)4"40"(/)'#%;&C
TQ% &CTTQ% U<Q% :4;,<% 6)4"40"(/)'% ,'5% 6/7)(@)'f% 7@"6/#(/0"6% ,7A6(0,'#9/0,#/% ,7()F)(A% )'%
5),E/(/#%1/66)(8#H%&(@/0"#76/0"#)#H%BVYDjKVfISSCIVDH%
WDX%_80,)%&Q%_)A,@,0,%RQ%38Z)1"("%iQ%_,(#85,%_Q%[,1/A,1,%_H%:4;,<%6)4"40"(/)'%,#%,%0)#G%
9,7("0% 9"0% 7"0"',0A% @/,0(% 5)#/,#/% ,'5% 7/0/E0,6% )'9,07()"'H% &(@/0"#76/0"#)#H%
BVYOjNVfBVVCIJKH%

Recent Advances in Cardiovascular Risk Factors

8
WKX%_,07"F)',%P_Q%&6E/0#%!!Q%P7,'8%&_Q%[/''/5A%>Q%c),7866)%3Q%U/02%[Q%="85/07%^Q%*,()%3Q%
^)9,)% iQ% P,G80,E,A,#@)% TQ% R,(/% !^Q% P(/)'1/(-% &H% e#/% "9% ,% 0/9/0/'7/% 1,(/0),6%
40"4"#/5% EA% (@/% T'(/0',()"',6% 3/5/0,()"'%"9%=6)')7,6%=@/1)#(0A%,'5%:,E"0,("0A%

_/5)7)'/% ("% /F,68,(/% ,',6A()7,6% 1/(@"5#% 9"0% (@/% 5/(/01)',()"'% "9% 46,#1,%
6)4"40"(/)';,<H%=6)'%=@/1H%IJJJjKOfBVNOCBVOSH%
WNX% *,()% 3Q% R,(/% !^Q% _,07"F)',% P_Q% P(/)'1/(-% &j% T'(/0',()"',6% 3/5/0,()"'% "9% =6)')7,6%
=@/1)#(0A% ,'5% :,E"0,("0A% _/5)7)'/j% T3==% L"0G)'2% c0"84% 9"0% :)4"40"(/)';,<%
&##,A% P(,'5,05)-,()"'H% 3)0#(% L>M`T3==% T'(/0',()"',6% ^/9/0/'7/% ^/,2/'(% 9"0%
:)4"40"(/)';,<%9"0%T118'",##,ACC:4;,<%P^_%IUH%=6)'%=@/1%:,E%_/5H%IJJKjKIfOSJC
OSOH%
WOX% P7,'8% &_Q% :,?'% ^_Q% U/02% [H% :)4"40"(/)';,<% ,'5% ,(@/0"#76/0"#)#H% &''% T'(/0'% _/5H%
BVVBjBBNfIJVCIBYH%
WSX%M0#l%aQ%&@0/'#%iQ%[)6,6)þ%*Q%P7@1)(-%cH%3,1)6),6%@A4/07@"6/#(/0"6/1),%,'5%6)4"40"(/)';,<%
@A4/06)4)5/1),% ,#% )'5/4/'5/'(% ,'5% 7"1E)'/5% 7,05)"F,#786,0% 0)#G% 9,7("0#H%
&(@/0"#76/0%P8446H%IJJVjBJfSKCSYH%
WYX% &0)A"% &&Q% R@,7@% =Q% R0,7A% ^j% =,05)"F,#786,0% >/,6(@% P(85A% T'F/#()2,("0#H% :4;,<%
6)4"40"(/)'Q% F,#786,0% 5)#/,#/Q% ,'5% 1"0(,6)(A% )'% (@/% /65/06AH% i% a'26% !% _/5H%
IJJDjDKVfIBJYCIBBNH%
WVX% i"05/#(2,,05% UcQ% =@,41,'% _!Q% ^,A% [Q% U"0$'% !Q% &'50/"(()% 3Q% L,((#% c3Q% c)'#E/02% >Q%
&1,0/'7"%.Q%=,(,4,'"%&Q%*/#7,14#%MPQ%3)#@/0%aQ%["F,'/'%.RQ%[8)F/'@"F/'%!&Q%
:/#')G% .Q% _,#,',% :Q% ^/)'/0% mQ% R,#G)'/'% _^Q% R"G2n-"268% :Q% RAEZo02C>,'#/'% &j%
a80"4/,'% &(@/0"#76/0"#)#% P"7)/(A% ="'#/'#8#% .,'/6H% :)4"40"(/)';,<% ,#% ,%
7,05)"F,#786,0%0)#G%9,7("0f%7800/'(%#(,(8#H%a80%>/,0(%!H%IJBJjDBfIYKKCIYNDH%%
WBJX% _,07"F)',% P_Q% ["#7@)'#GA% _:Q% &6E/0#% !!Q% PG,06,("#% PH% ^/4"0(% "9% (@/% i,()"',6% >/,0(Q%
:8'2Q% ,'5% U6""5% T'#()(8(/% L"0G#@"4% "'% :)4"40"(/)';,<% ,'5% =,05)"F,#786,0%
*)#/,#/f%0/7/'(%,5F,'7/#%,'5%98(80/%5)0/7()"'#H%=6)'%=@/1H%IJJDjKVfBSYNCBSVOH%
WBBX% U"99,% _UQ% _,07"F)',% P_Q% ["#7@)'#GA% _:H% :)4"40"(/)';,<% ,#% ,% 0)#G% 9,7("0% 9"0%
,(@/0"#76/0"#)#% ,'5% (@0"1E"#)#f% 1/7@,')#()7% )'#)2@(#% 90"1% ,')1,6% 1"5/6#H% =6)'%
U)"7@/1H%IJJKjDSfDDDCDKDH%%
WBIX%a1/02)'2%^)#G%3,7("0#%="66,E"0,()"'Q%a0b"8%PQ%[,4("2/%PQ%./00A%.:Q%*)%&'2/6,'("')"%aQ%
R@"14#"'% &Q% L@)(/% T^Q% _,07"F)',% P_Q% ="66)'#% ^Q% R@"14#"'% PcQ% *,'/#@% !H%
:)4"40"(/)';,<% 7"'7/'(0,()"'% ,'5% (@/% 0)#G% "9% 7"0"',0A% @/,0(% 5)#/,#/Q% #(0"G/Q% ,'5%
'"'F,#786,0%1"0(,6)(AH%!&_&H%IJJVjDJIfKBICKIDH%

WBDX%&'880,5%aQ%U"99,%_UQ%["#7@)'#GA%_:Q%U/0268'5%:H%:)4"40"(/)';,<f%,%8')b8/%0)#G%9,7("0%
9"0%7,05)"F,#786,0%5)#/,#/H%=6)'%:,E%_/5H%IJJOjIOfSNBCSSIH%
WBKX%U/02%[H%&%'/?%#/081%(A4/%#A#(/1%)'%1,'H%R@/%:.%#A#(/1H%&7(,%.,(@"6%_)70"E)"6%P7,'5H%
BVODjNVfDOVCDYIH%
WBNX%e(/01,''%cH%R@/%1A#(/0)/#%"9%6)4"40"(/)';,<H%P7)/'7/H%BVYVjIKOfVJKCVBJH%
WBOX%a0b"8%PQ%R@"14#"'%&Q%*)%&'2/6,'("')"%aQ%P,6/@//'%*Q%[,4("2/%PQ%_,07"F)',%PQ%*,'/#@%
!H%&4"6)4"40"(/)';,<%)#"9"01#%,'5%(@/%0)#G%"9%F,#786,0%5)#/,#/f%#A#(/1,()7%0/F)/?%"9%
KJ%#(85)/#%)'F"6F)'2%NYQJJJ%4,0()7)4,'(#H%!%&1%="66%=,05)"6H%IJBJjNNfIBOJCIBOSH%
WBSX% ^8E)'% !Q% [)1% >!Q% ./,0#"'% R&Q% >"66/0,'% PQ% U/0268'5% :Q% ^,1,G0)#@','% ^H% R@/%
,4"6)4"40"(/)';,<% 2/'/f% 6)'G,2/% 5)#/b8)6)E0),% ,(% (@0//% 6"7)% 5)99/0#% )'% &90)7,'%
&1/0)7,'#%,'5%=,87,#),'#H%&(@/0"#76/0"#)#H%IJJYjIJBfBDYCBKSH%%
WBYX%P)1l%!_Q%!"F/'%!Q%\)6/66,%aQ%^)E,#%_Q%.8Z,',%_&Q%P8'5,0,1%T_Q%>,11/6%!.Q%>""F/0C
.6"?% !:H% T14,7(% "9% ,4"6)4"40"(/)';,<% )#"9"01% #)-/% @/(/0"2/'/)(A% "'% (@/% 6A#)'/%

Lipoprotein (a) and Cardiovascular Risk

9
E)'5)'2%98'7()"'%"9%6)4"40"(/)';,<% )'% /,06A%"'#/(%7"0"',0A%,0(/0A%5)#/,#/H%R@0"1E%
>,/1"#(H%IJJBjYNfKBICKBSH%
WBVX%[0,9(%>cQ%:)'2/'@/6%&Q%.,'2%^LQ%*/64"0(%^Q%R0"11#5"099%_Q%\/01,,G%>Q%!,'8#%a*Q%
e(/01,''%cH%30/b8/'7A%5)#(0)E8()"'#%"9%,4"6)4"40"(/)';,<%G0)'26/%T\%0/4/,(%,66/6/#%
,'5% (@/)0% /99/7(#% "'% 6)4"40"(/)';,<% 6/F/6#% )'% =,87,#),'Q% &#),'Q% ,'5% &90)7,'%
4"486,()"'#f% (@/% 5)#(0)E8()"'% "9% '866% ,66/6/#% )#% '"'C0,'5"1H% a80% !% >81% c/'/(H%
BVVOjKfSKCYSH%
WIJX%L)66),1#%[!Q%36//#%c_Q%./(0)/%[&Q%P'A5/0%_:Q%U0"7),%^LQ%P?/'#"'%R:H%_/7@,')#1#%EA%
?@)7@% 6)4"40"(/)'% 6)4,#/% ,6(/0#% 7/6686,0% 1/(,E"6)#1% "9% 6)4"40"(/)';,<Q% 6"?% 5/'#)(A%
6)4"40"(/)'Q% ,'5% ',#7/'(% 6)4"40"(/)'#H% ^"6/#% 9"0% 6"?% 5/'#)(A% 6)4"40"(/)'% 0/7/4("0#%
,'5%@/4,0)'%#869,(/%40"(/"26A7,'#H%!%U)"6%=@/1H%BVVIjIOSfBDIYKCBDIVIH%
WIBX% i,08#7/?)7-% _Q% P/6)'2/0% aQ% *,F)2'"'% !H% M])5,()F/% 1"5)9)7,()"'% "9% 6)4"40"(/)';,<% ,'5%
(@/%/99/7(%"9%E/(,C7,0"(/'/H%_/(,E"6)#1H%BVVIjKBfBIBNCBIIKH%%

WIIX% m)"'7@/7G% R3Q% ."?/66% :_Q% ^)7/% c=Q% a,("'% *:Q% :,?'%^_H% T'(/0,7()"'% "9% 0/7"1E)','(%
,4"6)4"40"(/)';,<%,'5%6)4"40"(/)';,<%?)(@%1,70"4@,2/#H%!%=6)'%T'F/#(H%BVVBjYSfSOSC
SSBH%%
WIDX%R#)1)G,#%PQ%L)(-(81%!:H%R@/%0"6/%"9%"])5)-/5%4@"#4@"6)4)5#%)'%1/5),()'2%6)4"40"(/)';,<%
,(@/0"2/')7)(AH%=800%M4)'%:)4)5"6H%IJJYjBVfDOVCDSSH%%
WIKX% U/021,0G% =Q% */?,'% &Q% M0#"')% &Q% _/0G)% aQ% _)66/0% a^Q%P@)'% _!Q%U)'5/0%=!Q%>n0GGn%PQ%
[0,8##%^_Q%=@,41,'%_!Q%L)(-(81%!:Q%R#)1)G,#%PH%&%'"F/6%98'7()"'%"9%6)4"40"(/)'%
W,X% ,#% ,% 40/9/0/'(),6% 7,00)/0% "9% "])5)-/5% 4@"#4@"6)4)5#% )'% @81,'% 46,#1,H% !% :)4)5%
^/#H%IJJYjKVfIIDJCIIDVH%%
WINX% ["(,')% [Q% p,1,5,% PQ% e80(8A,% PQ% p,1,5,% RQ% R,')287@)% iQ% P,G80,E,A,#@)% TH% R@/%
,##"7),()"'% E/(?//'% E6""5% 2687"#/% ,'5% "])5)-/5% 6)4"40"(/)';,<% )'% @/,6(@A% A"8'2%
?"1/'H%:)4)5#%>/,6(@%*)#H%IJBJjVfBJDH%
WIOX% P,'5@"6-/0% =Q% P,@,% iQ% [,0G% !*Q% ^//#% &Q% !,0"##% LQ% *)/46)'2/0% >Q% >"44)7@6/0% 3Q%
U"/0?)'G6/%aQ%e(/01,''%cH%&4";,<%)#"9"01#%40/5)7(%0)#G%9"0%7"0"',0A%@/,0(%5)#/,#/H%
&%#(85A%)'%#)]%4"486,()"'#H%&0(/0)"#76/0%R@0"1EH%BVVIjBIfBIBKCBIIOH%
WISX% L)((084% >>Q% RAEZ,/05C>,'#/'% &Q% i"05/#(2,,05% UcH% :)4"40"(/)'% 6)4,#/% 18(,()"'#Q%
46,#1,% 6)4)5#% ,'5% 6)4"40"(/)'#Q% ,'5% 0)#G%"9%)#7@,/1)7%@/,0(%5)#/,#/H%&%1/(,C
,',6A#)#H%=)0786,()"'H%BVVVjVVfIVJBCIVJSH%%
WIYX% U"/0?)'G6/% aQ% :/99/0(% ==Q% :)'% !Q% :,7G'/0% =Q% =@)/#,% cQ% >"EE#%>>H% &4"6)4"40"(/)';,<%
2/'/% ,77"8'(#% 9"0% 20/,(/0% (@,'% VJd% "9% (@/% F,0),()"'% )'% 46,#1,% 6)4"40"(/)';,<%
7"'7/'(0,()"'#H%!%=6)'%T'F/#(H%BVVIjVJfNICOJH%
WIVX%_""#/0%\Q%P7@//0%*Q%_,07"F)',%P_Q%L,'2%!Q%c8/00,%^Q%="@/'%!Q%>"EE#%>>H%R@/%&4";,<%
2/'/% )#% (@/% 1,Z"0% 5/(/01)','(% "9% F,0),()"'% )'% 46,#1,% :4;,<% 6/F/6#% )'% &90)7,'%
&1/0)7,'#H%&1%!%>81%c/'/(H%BVVSjOBfKJICKBSH%
WDJX% L,'2% LQ% >8% *Q% ://% aRQ% 3,E#)(-% ^^Q% L/6(A% R[Q% ^"EE)'#% *=Q% !% :% p/@Q% >"?,05% U\H%
:)4"40"(/)';,<%)'%&1/0)7,'%T'5),'#%)#%6"?%,'5% '"(% )'5/4/'5/'(6A%,##"7),(/5%?)(@%
7,05)"F,#786,0%5)#/,#/H%R@/%P(0"'2%>/,0(%P(85AH%&''%a4)5/1)"6H%IJJIjBIfBJSCBBKH%
WDBX%m/6ZG"F)7%&Q%U"2,F,7CP(,'"Z/F)7%iQ%!/6)7CTF,'"F)7%mQ%P4,#"Z/F)7C[,6)1,'"F#G,%\Q%\/G)7%
!Q%P4,#)7%PH%="1E)'/5%/99/7(#%"9%#1,66%,4"6)4"40"(/)'%;,<%)#"9"01#%,'5%#1,66Q%5/'#/%
:*:%"'%7"0"',0A%,0(/0A%5)#/,#/%0)#GH%&07@%_/5%^/#H%IJJVjKJfIVCDNH%

WDIX%[0,9(%>cQ%:)'2/'@/6%&Q%.,'2%^LQ%*/64"0(%^Q%R0"11#5"099%_Q%\/01,,G%>Q%!,'8#%a*Q%
e(/01,''%cH%30/b8/'7A%5)#(0)E8()"'#%"9%,4"6)4"40"(/)';,<%G0)'26/%T\%0/4/,(%,66/6/#%
,'5% (@/)0% /99/7(#% "'% 6)4"40"(/)';,<% 6/F/6#% )'% =,87,#),'Q% &#),'Q% ,'5% &90)7,'%

Recent Advances in Cardiovascular Risk Factors

10
4"486,()"'#f% (@/% 5)#(0)E8()"'% "9% '866% ,66/6/#% )#% '"'C0,'5"1H% a80% !% >81% c/'/(H%
BVVOjKfSKCYSH%
WDDX% c8A("'% !^Q% *,@6/'% c>Q% .,(#7@% LQ% [,8(-% !&Q% c"(("% &_% !0H% ^/6,()"'#@)4% "9% 46,#1,%
6)4"40"(/)'% :4;,<% 6/F/6#% ("% 0,7/% ,'5% ("%,4"6)4"40"(/)'%UH%&0(/0)"#76/0"#)#H%
BVYNjNfIONCISIH%
WDKX% =@)8% :Q% >,11,'% ^3Q% [,1E"@% _TH% &4"6)4"40"(/)'% &% 4"6A1"04@)#1#% ,'5% 46,#1,%
6)4"40"(/)';,<% 7"'7/'(0,()"'#% )'% '"'C>)#4,')7% L@)(/#% ,'5% >)#4,')7#H% >81% U)"6H%
IJJJjSIfYIBCYDNH%
WDNX%U""1#1,%*TQ%[')Z99%.Q%[,4(/)'%&Q%:,E/80%=Q%_,0()'%icQ%>,F/G/#%:_Q%.0)'7/'%>_H%R@/%
/99/7(% "9% ,4"6)4"40"(/)';,<CQ% ,4"6)4"40"(/)'% aCQ% ,'5% ,4"6)4"40"(/)'% &KC%
4"6A1"04@)#1#% "'% b8,'()(,()F/% 6)4"40"(/)';,<% 7"'7/'(0,()"'#H% R?)'% ^/#H%
IJJJjDfBNICBNYH%
WDOX%.,86(0/%3Q%./,0#"'%R&Q%L/)6%>3Q%R87G%=>Q%_A/0#"'%_Q%^8E)'%!Q%30,'7)#%=[Q%_,0]%>3Q%
.@)6E)'%a3Q%^//5%^cQ%U/0268'5%:H%>)2@%6/F/6#%"9%:4;,<%?)(@%,%#1,66%,4";,<%)#"9"01%
,0/% ,##"7),(/5% ?)(@% 7"0"',0A% ,0(/0A% 5)#/,#/% )'% &90)7,'% &1/0)7,'% ,'5% ?@)(/% 1/'H%
&0(/0)"#76/0%R@0"1E%\,#7%U)"6H%IJJJjIJfIOBVCIOIKH%
WDSX% P/1,'% :!Q% _7i,1,0,% !^Q% P7@,/9/0% a!H% :)4"40"(/)';,<Q% @"1"7A#(/)'/Q% ,'5% 0/1','(6)G/%
4,0()76/#f%/1/02)'2%0)#G%9,7("0#H%=800%M4)'%=,05)"6H%BVVVjBKfBYOCBVBH%
WDYX%:,1"'C3,F,%PQ%_,07"F)',%P_Q%&6E/0#%!!Q%[/''/5A%>Q%*/687,%=Q%L@)(/%==Q%=8446/#%:&Q%
_7i,1,0,% !^Q% P/1,'% :!Q% U"'2,05% \Q% P7@,/9/0% a!H% :)4"40"(/)';,<% 6/F/6#Q% ,4";,<%
)#"9"01%#)-/Q%,'5%7"0"',0A%@/,0(%5)#/,#/%0)#G%)'%(@/%30,1)'2@,1%M99#40)'2%P(85AH%!%
:)4)5%^/#H%IJBBjNIfBBYBCBBYSH%%
WDVX%[0,9(%>cQ%[n7@6%PQ%_/'-/6%>!Q%P,'5@"6-/0%=Q%e(/01,''%cH%R@/%,4"6)4"40"(/)'%;,<%2/'/f%

,%(0,'#70)E/5%@A4/0F,0),E6/%6"78#%7"'(0"66)'2%46,#1,%6)4"40"(/)'%;,<%7"'7/'(0,()"'H%
>81%c/'/(H%BVVIjVJfIIJCDJH%
WKJX% ME/0% =Q% i"05% &PQ% R@"14#"'% aaQ% .,'% :Q% R,'% mQ% =8#,'"F)7@% *Q% P8'% pQ% i)7"6,/% ^Q%
a5/6#(/)'% =Q% P7@'/)5/0% *>Q% U)66#(0,'5% =Q% .9,99)'2/0% *Q% .@)66)4#% iQ% &'5/0#"'% ^:Q%
.@)6)4#% UQ% ^,Z,2"4,6,'% ^Q% >,(#8G,1)% RPQ% ^)/5/0% _!Q% >/,2/0(A% .!Q% i)7G/0#"'% *&Q%
&E'/A% _Q% _,07"F)',% PQ% !,0F)G% c.Q% P7,'8% &_Q% i)7"6,/% *:H% c/'"1/C?)5/%
,##"7),()"'% #(85A% "9% 46,#1,% 6)4"40"(/)';,<% 6/F/6#% )5/'()9)/#% 186()46/% 2/'/#% "'%
7@0"1"#"1/%ObH%!%:)4)5%^/#H%IJJVjNJfSVYCYJOH%%
WKBX% =0,?9"05% *=Q% ./'2% mQ% =@/'2% !3Q% U"99/66)% *Q%&@/,0'%_Q%i28A/'%*Q%P@,99/0%RQ%p)%qQ%
:)F)'2#("'% ^!Q% ^)/5/0% _!Q% i)7G/0#"'% *&H% :.&% ,'5% .:c% #/b8/'7/% F,0),()"'% ,'5%
G0)'26/%T\CI%7"4A%'81E/0%)'%(?"%4"486,()"'#H%>81%>/0/5H%IJJYjOOfBVVCIJVH%%
WKIX% =6,0G/% ^Q% ./5/'% !3Q% >"4/?/66% !=Q% [A0),G"8% RQ% c"/6% &Q% >/,(@% P=Q% .,0)#@% PQ% U,06/0,% PQ%
30,'-"#)% _cQ% ^8#(% PQ% U/''/((% *Q% P)6F/)0,% &Q% _,6,0#()2% &Q% c0//'% 3^Q% :,(@0"4% _Q%
c)2,'(/% UQ% :/,'5/0% [Q% 5/% 3,)0/% eQ% P//5"09% eQ% >,1#(/'% &Q% ="66)'#% ^Q% L,(G)'#% >Q%
3,00,66% _j% .^M=&^*TP% ="'#"0()81H% c/'/()7% F,0),'(#% ,##"7),(/5% ?)(@% :4;,<%
6)4"40"(/)'%6/F/6%,'5%7"0"',0A%5)#/,#/H%i%a'26%!%_/5H%IJJVjDOBfINBYCINIYH%
WKDX%_""#/0%\Q%P7@//0%*Q%_,07"F)',%P_Q%L,'2%!Q%c8/00,%^Q%="@/'%!Q%>"EE#%>>H%R@/%&4";,<%
2/'/% )#% (@/% 1,Z"0% 5/(/01)','(% "9% F,0),()"'% )'% 46,#1,% :4;,<% 6/F/6#% )'% &90)7,'%
&1/0)7,'#H%&1%!%>81%c/'/(H%BVVSjOBfKJICKBSH%
WKKX%_,07"F)',%P_Q%&6E/0#%!!Q%L)Z#1,'%aQ%m@,'2%mQ%=@,41,'%i>Q%[/''/5A%>H%*)99/0/'7/#%
)'% :4W,X% 7"'7/'(0,()"'#% ,'5% ,4"W,X% 4"6A1"04@#% E/(?//'% E6,7G% ,'5% ?@)(/%
&1/0)7,'#H%!%:)4)5%^/#H%BVVOjDSfINOVCINYNH%

Lipoprotein (a) and Cardiovascular Risk

11
WKNX%=@0/()/'%!.Q%="0/#@%!Q%U/0(@)/0CP7@,,5%pQ%[,"%L>Q%3)'G%iaQ%[6,2%_!Q%_,07"F)',%P_Q%
c),7866)%3Q%P1)(@%_LH%R@0//%#)'26/C'876/"()5/%4"6A1"04@)#1#%)'%:.&%,77"8'(%9"0%
1"#(% "9% (@/% )'70/,#/% )'% 6)4"40"(/)';,<% 6/F/6% /6/F,()"'% )'% &90)7,'% &1/0)7,'#%
7"14,0/5%?)(@%a80"4/,'%&1/0)7,'#H%!%_/5%c/'/(H%IJJOjKDfVBSCVIDH%%

WKOX%*81)(0/#78%:Q%c6/''%[Q%U0"?'Cc/'(0A%[Q%P@/4@,05%=Q%L"'2%_Q%^)/5/0%_!Q%P1)(@%!*Q%
i)7G/0#"'%*&Q%=0,?9"05%*=H% \,0),()"'% )'% :.&% )#%,##"7),(/5%?)(@% :4;,<% 6/F/6#% )'%
(@0//% 4"486,()"'#% 90"1% (@/% R@)05% i,()"',6% >/,6(@% ,'5% i8(0)()"'% a],1)',()"'%
P80F/AH%.:"P%M'/H%IJBBjOf/BOOJKH%
WKSX%[0,9(%>cQ%>,)E,7@%=Q%:)'2/'@/6%&Q%U08''/0%=Q%R0"11#5"099%_Q%[0"'/'E/02%3Q%_k66/0%
>!Q% e(/01,''% cH% P/b8/'7/% 4"6A1"04@)#1% )'% G0)'26/% T\% DS% )'% 6)'G,2/%
5)#/b8)6)E0)81% ?)(@% (@/% ,4"6)4"40"(/)'% ;,<% #)-/% 4"6A1"04@)#1H% >81% c/'/(H%
BVVNjVNfISNCIYIH%
WKYX%*,'2,#%cQ%&1E0"#/%!&Q%*r&2,(/%*!Q%P@,"%!>Q%=@"7G,6)'2@,1%PQ%:/F)'/%*Q%P1)(@%*&H%
="00/6,()"'%"9%#/081%6)4"40"(/)';,<%?)(@%(@/%,'2)"20,4@)7%,'5%76)')7,6%40/#/'(,()"'%
"9%7"0"',0A%,0(/0A%5)#/,#/H%&1%!%=,05)"6H%BVVVjYDfNYDCNYNH%
WKVX%*/#1,0,)#%^:Q%P,0/1E"7G%T!Q%&A/0#%=^Q%\/0'"'%P_Q%."?/0#%a^Q%c)146/%:LH%a6/F,(/5%
#/081% 6)4"40"(/)';,<% )#% ,% 0)#G% 9,7("0% 9"0% 76)')7,6% 0/7800/'7/% ,9(/0% 7"0"',0A% E,66""'%
,'2)"46,#(AH%=)0786,()"'H%BVVNjVBfBKJDCBKJVH%
WNJX%>"99%>3Q%U/7G%c!Q%PG)E)'#G)%=TQ%!k02/'#%cQ%Mri/)6%!Q%[0,1/0%!Q%:A(6/%UH%P/081%:4;,<%6/F/6%
,#%,%40/5)7("0%"9%F/)'%20,9(%#(/'"#)#%,9(/0%7"0"',0A%,0(/0A%EA4,##%#802/0A%)'%4,()/'(#H%
=)0786,()"'H%BVYYjSSfBIDYCBIKKH%
WNBX% U"#("1% &cQ% =8446/#% :&Q% !/''/0% !:Q%M05"F,#% !_Q% P/1,'% :!Q% L)6#"'% .LQ% P7@,/9/0% a!Q%
=,#(/66)% L.H% a6/F,(/5% 46,#1,% 6)4"40"(/)';,<% ,'5% 7"0"',0A% @/,0(% 5)#/,#/% )'% 1/'%
,2/5%NN%A/,0#%,'5%A"8'2/0H%&%40"#4/7()F/%#(85AH%!&_&H%BVVOjISOfNKKCNKYH%
WNIX% U/''/(% &Q% *)% &'2/6,'("')"% aQ% a0b"8% PQ% a)0)G#5"(()0% cQ% P)2805##"'% cQ% L""5?,05% _Q%
^816/A% &Q% :"?/% c*Q% *,'/#@% !Q% c85',#"'% \H% :)4"40"(/)';,<% 6/F/6#% ,'5% 0)#G% "9%
98(80/% 7"0"',0A% @/,0(% 5)#/,#/f% 6,02/C#7,6/% 40"#4/7()F/% 5,(,H% &07@% T'(/0'% _/5H%
IJJYjBOYfNVYCOJYH%
WNDX%*,'/#@%!Q%="66)'#%^Q%./("%^H%:)4"40"(/)';,<%,'5%7"0"',0A%@/,0(%5)#/,#/H%_/(,C,',6A#)#%"9%
40"#4/7()F/%#(85)/#H%=)0786,()"'H%IJJJjBJIfBJYICBJYNH%
WNKX% _,07"F)',% P_Q% ["#7@)'#GA% _:H% &% 70)()7,6%/F,68,()"'%"9%(@/%0"6/%"9%:4;,<%)'%
7,05)"F,#786,0%5)#/,#/f% 7,'% :4;,<% E/% 8#/986% )'% 0)#G% ,##/##1/'(s% P/1)'% \,#7% _/5H%
IJJIjIfDDNCDKKH%
WNNX% T2,0,#@)% pQ% [,#,)% >Q% p,1,#@)(,% 3Q% P,("% RQ% T'8-8G,% >Q% MZ)1,% [Q% &)-,?,% pH%

:)4"40"(/)';,<Q%6/9(%,(0),6%,44/'5,2/%98'7()"'%,'5%(@0"1E"/1E"6)7%0)#G%)'%4,()/'(#%
?)(@%7@0"')7%'"'F,6F86,0%,(0),6%9)E0)66,()"'H%!4'%=)07%!H%IJJJjOKfVDCVYH%
WNOX%_"6)(/0'"%*!Q%:,'2/%^&Q%_/)5/66%^PQ%L)66,05%!aQ%:/99/0(%==Q%c/0,05%^*Q%U"/0?)'G6/%aQ%
>"EE#%>>Q%>)66)#%:*H%^/6,()"'%"9%46,#1,%6)4"40"(/)';,<%("%)'9,07(%,0(/0A%4,(/'7A%)'%
#80F)F"0#%"9%1A"7,05),6%)'9,07()"'H%=)0786,()"'H%BVVDjYYfVDNCVKJH%
WNSX% ^)5G/0% ._Q% P(,149/0% _!Q% ^)9,)% iH% i"F/6% 0)#G% 9,7("0#% 9"0% #A#(/1)7% ,(@/0"#76/0"#)#f% ,%
7"14,0)#"'% "9% =C0/,7()F/% 40"(/)'Q% 9)E0)'"2/'Q% @"1"7A#(/)'/Q% 6)4"40"(/)';,<Q% ,'5%
#(,'5,05%7@"6/#(/0"6%#70//')'2%,#% 40/5)7("0#%"9%4/0)4@/0,6%,0(/0),6%5)#/,#/H%!&_&H%
IJJBjIYNfIKYBCIKYNH%
WNYX%_"6)(/0'"%*!Q%!"G)'/'%a\Q%_)#/0/-%&^Q%:,'2/%^&Q%L)66,05%!aQ%U"/0?)'G6/%aQ%>)66)#%:*Q%
>"EE#%>>H%i"% ,##"7),()"'%E/(?//'%46,#1,%6)4"40"(/)';,<%7"'7/'(0,()"'#%,'5%(@/%

Recent Advances in Cardiovascular Risk Factors

12
40/#/'7/%"0%,E#/'7/%"9%7"0"',0A%,(@/0"#76/0"#)#%)'%&90)7,'C&1/0)7,'#H%&0(/0)"#76/0%
R@0"1E%\,#7%U)"6H%BVVNjBNfYNJCYNNH%
WNVX% &G,'Z)% &MH% &4";,<% )#"9"01#% 5"% '"(% 40/5)7(% 0)#G% 9"0% 7"0"',0A% @/,0(% 5)#/,#/% )'% ,% c869%
&0,E%4"486,()"'H%&''%=6)'%U)"7@/1H%IJJJjDS;.(%D<fDOJCDOOH%
WOJX% P1"65/0#% UQ% :/11/'#% ^Q% R@)Z#% \H% :)4"40"(/)'% ;,<% ,'5% #(0"G/f% ,% 1/(,C,',6A#)#% "9%
"E#/0F,()"',6%#(85)/#H%P(0"G/H%IJJSjDYfBVNVCBVOOH%%
WOBX%P@)'(,')%PQ%[)G87@)%PQ%>,1,287@)%>Q%P@))2,)%RH%>)2@%#/081%6)4"40"(/)';,<%6/F/6#%,0/%,'%
)'5/4/'5/'(%0)#G%9,7("0%9"0%7/0/E0,6%)'9,07()"'H%P(0"G/H%BVVDjIKfVONCVOVH%
WOIX% &0)A"% &&Q% R@,7@% =Q% R0,7A% ^j% =,05)"F,#786,0% >/,6(@% P(85A% T'F/#()2,("0#H% :4;,<%
6)4"40"(/)'Q% F,#786,0% 5)#/,#/Q% ,'5% 1"0(,6)(A% )'% (@/% /65/06AH% i% a'26% !% _/5H%
IJJDjDKVfIBJYCIBBNH%
WODX% _)6)"')#% >!Q% 3)6)44,("#% R*Q% :"8G,#% RQ% U,)0,G(,0)% aRQ% R#/6/4)#% &*Q% a6)#,9% _PH% P/081%
6)4"40"(/)';,<%6/F/6#%,'5%,4"6)4"40"(/)';,<%)#"9"01%#)-/%,'5%0)#G%9"0%9)0#(C/F/0%,78(/%
)#7@,/1)7%'"'/1E"6)7%#(0"G/%)'%/65/06A%)'5)F)58,6#H%&(@/0"#76/0"#)#H%IJJO6jBYSfBSJC
BSOH%%

WOKX% MG80,% >Q% T'"8/% >Q% R"1"'% _Q% i)#@)A,1,% PQ% p"#@)G,?,% RH% T'70/,#/5% 46,#1,%
6)4"40"(/)';,<% 6/F/6% )'% 7,05)"/1E"6)7% #(0"G/% ?)(@% '"'CF,6F86,0% ,(0),6% 9)E0)66,()"'H%
T'(/0'%_/5H%BVVYjDSfVVNH%%
WONX%L)E/02%UQ%P8'5#(0n1%!Q%&0'6nF%!Q%R/0$'(%&Q%\/##EA%UQ%m/(@/6)8#%UQ%:)'5%:H%_/(,E"6)7%0)#G%
9,7("0#%9"0%#(0"G/%,'5%(0,'#)/'(%)#7@/1)7%,((,7G#%)'%1)556/C,2/5%1/'f%,%7"118')(AC
E,#/5%#(85A%?)(@%6"'2C(/01%9"66"?C84H%P(0"G/H%IJJOjDSfIYVYCIVJDH%%
WOOX%!,1)/#"'%*cQ%38%:Q%e#@/0%*=Q%:,F)%aH%*/(/7()"'%"9%6)4"40"(/)';,<%)'%)'(0,4,0/'7@A1,6%
7/0/E0,6%F/##/6#f%7"00/6,()"'%?)(@%F,#786,0%4,(@"6"2A%,'5%76)')7,6%@)#("0AH%a]4%_"6%
.,(@"6H%IJJBjSBfVVCBJNH%
WOSX% i,2,0,Z% P[Q% .,)% .Q% U@,(% cQ% >/1,6,(@,% &H%:)4"40"(/)'%;,<%,'5%"(@/0%:)4)5%.0"9)6/%)'%
.,()/'(#% ?)(@% R@0"1E"()7% P(0"G/f% T#% )(% ,% ^/6),E6/% _,0G/0s% !% :,E% .@A#)7),'#H%
IJBBjDfIYCDIH%
WOYX% ="0/#@% !Q% :"'2/'/7G/0% !=Q% _)66/0% a^% D05Q% p"8'2% >!Q% [6,2% _!H% a4)5/1)"6"2A% "9%
7,05)"F,#786,0% 0)#G% 9,7("0#% )'% 7@0"')7% 0/',6% 5)#/,#/H% !% &1% P"7% i/4@0"6H% BVVYjV;BI%
P8446<fPIKCDJH%
WOVX% *+,-C./0"1)'2"% !&Q% =,0E,Z,6% *cQ% &6Et'CP,62,5"% &H% :)4"40"(/)'% ;,<% )'% 4,()/'(#% "'%
@/1"5),6A#)#H%&7(,%_/5%&8#(0),7,H%IJJKjDBfSDCSNH%
WSJX%*/Z,'"F,%UQ%3)6)47/%\Q%*/Z,'"F%.Q%P)G"6/%&Q%c0"-5,'"F#G)%^Q%_,6/#G,%\H%&(@/0"#76/0"#)#%
0)#G% 9,7("0#% 0/6,(/5% ("% @/1"5),6A#)#% 580,()"'% ,'5% /0A(@0"4")/()'% (@/0,4AH% =6)'%
=@/1%:,E%_/5H%IJJBjDVfKYKCKYOH%
WSBX%[,A#/'% c&H% :)4)5% ,'5%6)4"40"(/)'% 1/(,E"6)#1% )'% 7@0"')7% G)5'/A% 5)#/,#/H% !% ^/'% i8(0H%
IJJVjBVfSDCSSH%
WSIX%>""F/0C.6"?%!Q%>,0(%aQ%c"'2%pQ%P@7@80)'%&Q%P7@'//1,'%RH%&%4@A#)"6"2)7,6%98'7()"'%9"0%
,4"6)4"40"(/)';,<f%,%',(80,6%0/286,("0%"9%(@/%)'96,11,("0A%0/#4"'#/H%a]4%U)"6%_/5%
;_,A?""5<H%IJJVjIDKfIYCDKH%%
WSDX% 36/)#7@1,''% a>Q% U"?/0% !*Q% P,6,@85//'% &[H% &0/% 7"'F/'()"',6% 7,05)"F,#786,0% 0)#G%
9,7("0#% 40/5)7()F/% "9% (?"CA/,0% 1"0(,6)(A% )'% @/1"5),6A#)#% 4,()/'(#s% =6)'% i/4@0"6H%
IJJBjNOfIIBCIDJH%
WSKX%M-5/1)0%3iQ%ck-%cQ%P/-/0%PQ%&0,(%mQ%R80,'%_Q%>,E/0,6%_H%&(@/0"#76/0"#)#%0)#G%)#%@)2@/0%
)'% 7"'()'8"8#% ,1E86,("0A% 4/0)("'/,6% 5),6A#)#% 4,()/'(#% (@,'%)'%@/1"5),6A#)#%

4,()/'(#H%&0()9%M02,'#H%IJJBjINfKKYCKNIH%

Lipoprotein (a) and Cardiovascular Risk

13
WSNX% [0"'/'E/02% 3Q% :)'2/'@/6% &Q% i/A/0% eQ% :@"((,% [Q% [n')2% .Q% &8)'2/0% _Q% L)/#@"6-/0% _Q%
&'5/0##"'% >Q% *)/46)'2/0% >H% .0/F,6/'7/% "9% 5A#6)4)5/1)7% 0)#G% 9,7("0#% )'%
@/1"5),6A#)#%,'5%=&.*%4,()/'(#H%[)5'/A%T'(%P8446H%IJJDjYKfBBDCBBOH%
WSOX% T2,0,#@)% pQ% p,1,80,% _Q% T("% _Q% T'8-8G,% >Q% MZ)1,% [Q% &)-,?,% pH% a6/F,(/5% #/081%
6)4"40"(/)';,<% )#% ,% 0)#G% 9,7("0% 9"0% 6/9(% ,(0),6%(@0"1E8#%)'%4,()/'(#%?)(@%7@0"')7%,(0),6%
9)E0)66,()"'f%,%(0,'#/#"4@,2/,6%/7@"7,05)"20,4@)7%#(85AH%&1%>/,0(%!H%BVVYjBDOfVONCVSBH%
WSSX%=/6)G%PQ%U,AG,'%_Q%M0/1%=Q%[)6)'u%[Q%M0/1%&Q%a05n6%=Q%[,46,'%PH%P/081%6)4"40"(/)';,<%
,'5% )(#% 0/6,()"'% ("% 6/9(% F/'(0)786,0% (@0"1E8#% )'% 4,()/'(#% ?)(@% ,78(/% 1A"7,05),6%
)'9,07()"'H%!4'%>/,0(%!H%IJJBjKIfNCBKH%
WSYX% *+,-C./0"1)'2"% !&Q% &6Et'CP,62,5"% &Q% c,07+,CP8t0/-% 3Q% Pt'7@/-C:/)0,% !Q% P,E"0)5"C
30"Zt'%!Q%T26/#),#Cc,66/2"%_H%:)4"40"(/)';,<%,'5%6)4)5%40"9)6/%)'%4,()/'(#%?)(@%,(0),6%
9)E0)66,()"'H%_/5%P7)%_"')(H%IJJOjBIfBIICBINH%
WSVX%_7:/,'%!LQ%R"16)'#"'%!aQ%[8,'2%L!Q%a,("'%*:Q%=@/'%apQ%36/##%c_Q%P7,'8%&_Q%:,?'%
^_H%7*i&% #/b8/'7/% "9% @81,'% ,4"6)4"40"(/)';,<% )#% @"1"6"2"8#% ("% 46,#1)'"2/'H%
i,(80/H%BVYSjDDJfBDICBDSH%
WYJX% :"#7,6-"% !Q% L/)'9/65% _Q% 36/##% c_Q% P7,'8% &_H% :)4"40"(/)';,<Q% 9)E0)'% E)'5)'2Q% ,'5%
46,#1)'"2/'%,7()F,()"'H%&0(/0)"#76/0"#)#H%BVVJjBJfIKJCIKNH%
WYBX%=,46)7/%i_Q%.,'/((,%=Q%./(/0#"'%RaQ%[6/44/%:PQ%_8/#G/%=PQ%["#('/0%c_Q%U0"-/%c!%!0Q%
P)1,0)%^*H%:)4"40"(/)'%;,<%E)'5#%,'5%)',7()F,(/#%()##8/%9,7("0%4,(@?,A%)'@)E)("0f%,%
'"F/6%6)'G%E/(?//'%6)4"40"(/)'#%,'5%(@0"1E"#)#H%U6""5H%IJJBjVYfIVYJCIVYSH%
WYIX% U8/7@6/0% =Q% e660)7@% >Q% ^)((/0% _Q% ."0#7@CM/-78/08/1/-% _Q% :,7G'/0% [!Q% U,06,2/% PQ%
30)/50)7@%PMQ%["#('/0%c_Q%P7@1)(-%cH%:)4"40"(/)'%;,<%84C0/286,(/#%(@/%/]40/##)"'%
"9% (@/% 46,#1)'"2/'% ,7()F,("0% )'@)E)("0% I% )'% @81,'% E6""5% 1"'"7A(/#H% U6""5H%
IJJBjVSfVYBCVYOH%
WYDX% >,ZZ,0% [&Q% c,F)#@% *Q% U0/#6"?% !:Q% i,7@1,'% ^:H% :)4"40"(/)';,<% 1"586,()"'% "9%

/'5"(@/6),6%7/66%#809,7/%9)E0)'"6A#)#%,'5%)(#%4"(/'(),6%0"6/%)'%,(@/0"#76/0"#)#H%i,(80/H%
BVYVjDDVfDJDCDJNH%
WYKX%^)11%aUQ%L)66),1#%.Q%3"#@/0%[Q%=0)b8)%_Q%P(,149/0%_!H%_"5/0,(/%,67"@"6%)'(,G/%,'5%
6"?/0% 0)#G% "9% 7"0"',0A% @/,0(% 5)#/,#/f% 1/(,C,',6A#)#% "9% /99/7(#% "'% 6)4)5#% ,'5%
@,/1"#(,()7%9,7("0#H%U_!H%BVVVjDBVfBNIDCBNIYH%
WYNX% ^/@1% !Q% c1/6% cQ% P/14"#% =RQ% R0/F)#,'% _H% &67"@"6C0/6,(/5% 1"0E)5)(A% ,'5% 1"0(,6)(AH%
&67"@"6%^/#%>/,6(@H%IJJDjISfDVCNBH%
WYOX%["6"F"8%c*Q%P,64/,%[*Q%&',2'"#("4"86"8%[[Q%_)G@,)6)5)#%*.H%&67"@"6%8#/Q%F,#786,0%
5)#/,#/Q%,'5%6)4)5C6"?/0)'2%5082#H%!%.@,01,7"6%a]4%R@/0H%IJJOjDBYfBCSH%%
WYSX%Un@1%_Q%^"#/'G0,'-%PQ%:,89#%eH%&67"@"6%,'5%0/5%?)'/f%)14,7(%"'%7,05)"F,#786,0%0)#GH%
i/4@0"6%*),6%R0,'#46,'(H%IJJKjBVfBBCOH%
WYYHX% L,'2% !&Q% =@/'% v3Q% p8% L3Q% =@/'% >Q% :)'% v3Q% v),'2% _!Q% 3,'2% =3Q% *8% pvQ% L,'2% UH%
^/6,()"'#@)4%"9%@/,FA%50)'G)'2Q%6)4"40"(/)'%;,<%,'5%6)4)5%40"9)6/%("%)'90,0/',6%,"0()7%
5),1/(/0H%\,#7%_/5H%IJJVjBKfDIDCDIVH%
WYVX%P"9)%3Q%_,07877)%^Q%c)8#()%UQ%.0,(/#)%cQ%:,0)%UQ%P/#()')%TQ%:"%P,4)"%.Q%.866)%^Q%.0,(/#)%=Q%
&EE,(/% ^Q% c/'#)')% c3H% >)2@% 6/F/6#% "9% @"1"7A#(/)'/Q% 6)4"40"(/)'% ;,<% ,'5%
46,#1)'"2/'% ,7()F,("0% )'@)E)("0CB% ,0/% 40/#/'(% )'% 4,()/'(#% ?)(@% ,E5"1)',6% ,"0()7%
,'/80A#1H%R@0"1E%>,/1"#(H%IJJNjVKfBJVKCBJVYH%
WVJX% ./(/0#/'% aQ% Lw2E/02% 3Q% &'2b8)#(% [&H% *"/#% 6)4"40"(/)';,<% )'@)E)(% /6,#("6A#)#% )'%
,E5"1)',6%,"0()7%,'/80A#1#s%a80%!%\,#7%a'5"F,#7%P802H%IJJDjIOfKIDCKIYH%

Recent Advances in Cardiovascular Risk Factors

14
WVBX%.,0@"9/0% [cH% :)4"40"(/)';,<f% 1/5)7,6% (0/,(1/'(%"4()"'#% 9"0%,'%/68#)F/%1"6/786/H% =800%
.@,01%*/#H%IJBBjBSfYSBCYSOH%
WVIX%_7[/''/A%!H%i/?%4/0#4/7()F/#%"'%(@/%8#/%"9%'),7)'%)'%(@/%(0/,(1/'(%"9%6)4)5%5)#"05/0#H%
&07@%T'(/0'%_/5H%IJJKjBOKfOVSCSJNH%%
WVDX% =@,#1,'% *TQ% P@)991,'% *Q% m//% ^pQ% :"8)/% !mQ% :8G/% __Q% ^"?6,'5% =_Q% =,(,'/#/% !!Q%
U80)'2% !aQ% */F6)'% !!Q% ^)5G/0% ._H% ."6A1"04@)#1% )'% (@/% ,4"6)4"40"(/)';,<% 2/'/Q%

46,#1,% 6)4"40"(/)';,<Q% 7,05)"F,#786,0% 5)#/,#/Q% ,'5% 6"?C5"#/% ,#4)0)'% (@/0,4AH%
&(@/0"#76/0"#)#H%IJJVjIJDfDSBCDSOH%
WVKX%c,6F,'"%3Q%:)%\"6()%cQ%_,6,28,0'/0,%_Q%&F)(,E)6/%RQ%&'()7%RQ%\,7,'(/%_Q%_,6,28,0'/0,%_H%
a99/7(#% "9% #)1F,#(,()'% ,'5% 7,0')()'/% F/0#8#% #)1F,#(,()'% "'% 6)4"40"(/)';,<% ,'5%
,4"40"(/)';,<%)'%(A4/%I%5),E/(/#%1/66)(8#H%a]4/0(%M4)'%.@,01,7"(@/0H%IJJVjBJfBYSNCBYYIH%
WVNX%_7[/''/A%!_Q%!"'/#%.>Q%U,A#%>aQ%['"44%^>Q%[,#@A,4%_:Q%^8"99%caQ%_7c"F/0'%_aH%
="14,0,()F/% /99/7(#% "'% 6)4)5% 6/F/6#% "9% 7"1E)',()"'% (@/0,4A% ?)(@% ,% #(,()'% ,'5%
/](/'5/5C0/6/,#/%'),7)'% "0%/-/()1)E/%F/0#8#% ,%#(,()'%,6"'/%;(@/% =M_.a::% #(85A<H%
&(@/0"#76/0"#)#H%IJJSjBVIfKDICKDSH%%
WVOX% c"'E/0(% PQ% _,6)'#GA% PQ% P4"#)("% &=Q% :,"8/','% >Q% *"87/(% =Q% =@,41,'% _!Q% R@)66/(% !H%
&("0F,#(,()'% 6"?/0#% 6)4"40"(/)';,<% E8(% '"(% ,4"6)4"40"(/)';,<% 90,21/'(% 6/F/6#% )'%
@A4/07@"6/#(/0"6/1)7% #8EZ/7(#% ,(% @)2@% 7,05)"F,#786,0% 0)#GH% &(@/0"#76/0"#)#H%
IJJIjBOKfDJNCDBBH%
WVSX% .,'% !Q% \,'% !RQ% =@,'% aQ% [/#,6,% ^:Q% :)'% _Q% =@,06/#% _&H% a](/'5/5C0/6/,#/% '),7)'%
(0/,(1/'(% "9% (@/% ,(@/0"2/')7% 6)4)5% 40"9)6/% ,'5% 6)4"40"(/)';,<% )'% 5),E/(/#H%
_/(,E"6)#1H%IJJIjNBfBBIJCBBISH%
WVYX%P7@,/9/0%a!Q%_7i,1,0,%!^Q%R,A6/0%RQ%*,6A%!&Q%c6/,#"'%!:Q%P/1,'%:!Q%3/00,0)%&Q%^8E/'#(/)'%
!!H% ="14,0)#"'#% "9% /99/7(#% "9% #(,()'#% ;,("0F,#(,()'Q% 968F,#(,()'Q% 6"F,#(,()'Q% 40,F,#(,()'Q%
,'5% #)1F,#(,()'<% "'% 9,#()'2% ,'5% 4"#(40,'5),6% 6)4"40"(/)'#% )'% 4,()/'(#% ?)(@% 7"0"',0A%
@/,0(%5)#/,#/%F/0#8#%7"'(0"6%#8EZ/7(#H%&1%!%=,05)"6H%IJJK%!,'%BjVD;B<fDBCVH%
WVVX%U/66%*&Q%>""4/0%&!Q%U80'/((%!^H%_)4"1/0#/'Q%,'%,'()#/'#/%,4"6)4"40"(/)'%U%#A'(@/#)#%
)'@)E)("0H%a]4/0(%M4)'%T'F/#()2%*082#H%IJBBjIJfIONCISIH%%
WBJJX%&'2/6)'%UQ%^856)'2%_H%:)4)5%6"?/0)'2%?)(@%(@A0")5%@"01"'/%,'5%(@A0"1)1/()7#H%=800%
M4)'%:)4)5"6H%IJBJjIBfKVVCNJOH%
WBJBX%./00"'/%cQ%=,40)%MQ%c,6"44)%.Q%U08'/66)%^Q%U/F)6,7b8,%aQ%=/7)%3Q%=),06,%_\Q%P(0"1%^H%
a99/7(#% "9% /)(@/0% ()E"6"'/% "0% 7"'()'8"8#% 7"1E)'/5% (0,'#5/01,6% /#(0,5)"6% ?)(@%
1/50"]A40"2/#(/0"'/% ,7/(,(/% "'% 7",286,("0A% 9,7("0#% ,'5% 6)4"40"(/)';,<% )'%
1/'"4,8#/H%cA'/7"6%ME#(/(%T'F/#(H%IJJVjOYfDDCDVH%
WBJIX% *,@/0% ^Q% &6C&1)'% >Q% U/,)')% _Q% e#(,% TH%a99/7(%"9%()E"6"'/%(@/0,4A%"'%6)4)5#%,'5%
7",286,()"'%)'5)7/#H%=6)'%=@/1%:,E%_/5H%IJJOjKKfBKVYCBKVVH%%

WBJDX%%R#/61)'%PQ%P7@1)(-%cQ%!86)8#%eQ%U"0'#(/)'%P^Q%U,0(@/6%&Q%c0,/##6/0%!H%&78(/%/99/7(#%"9%
6)4)5%,4@/0/#)#%"'%@81,'%#/081%6)4)5"1/H%&(@/0"#76/0%P8446H%IJJVjBJfISCDDH%
WBJKX%!,/2/0% U^Q% ^)7@(/0% pQ%i,2/6%*Q% >/)26%3Q%\"2(% &Q% ^"/#/6/0%aQ%.,0@"9/0%[Q% ^,16"?% LQ%
["7@% _Q% e(/01,''% cQ% :,E,00/0/% =&Q% P/)5/6% *j% c0"84% "9% =6)')7,6% T'F/#()2,("0#H%
:"'2)(85)',6% 7"@"0(% #(85A% "'% (@/% /99/7()F/'/##% "9% 6)4)5% ,4@/0/#)#% (0/,(1/'(% ("%
0/587/%@)2@%6)4"40"(/)';,<%6/F/6#%,'5%40/F/'(%1,Z"0%,5F/0#/%7"0"',0A%/F/'(#H%i,(%
=6)'%.0,7(%=,05)"F,#7%_/5H%IJJVjOfIIVCIDVH%
2
Remnant Lipoproteins are a Stronger
Risk Factor for Cardiovascular Events
than LDL-C > From the Studies of
Autopsies in Sudden Cardiac Death Cases
!"#$%&%'()*"'"+(,"
/)
"01)2"$"'()34)5%+(#"
/)
1
Graduate School of Health Sciences, Gunma University, Maebashi, Gunma,
2
Department of Legal Medicine (Forensic Medicine),
Keio University School of Medicine, Shinjuku-ku, Tokyo,
Japan
1. Introduction
67"$,")898:;)7<=<7)($)#><),?$#)@<77)<$#"A7($><1)B($')C"D#?B)C?B)D?B?0"B&)><"B#)1($<"$<)E;F9G)
E-G4)HDD?B1(0I7&.)#><)0%,<B?%$)$#%1(<$)>"=<)$>?@0)#>"#)#><)898:;)7?@<B(0I)1B%I$.)$#"#(0$)
$(I0(C(D"0#7&) B<1%D<1) J7"$,") 898:;) #?I<#><B) @(#>) "JJB?K(,"#<7&) LMN) B<1%D#(?0) (0)
D"B1(?="$D%7"B)<=<0#$) E/G4)O><B<C?B<.)(#)>"$)A<<0)I<0<B"77&)A<7(<=<1)#>"#)#><)D"B1(?="$D%7"B)
<=<0#$)"B<)1(B<D#7&)"$$?D("#<1)@(#>)#><)<7<="#<1)898:;)?B)(#$),?1(C(<1)?K(1(P<1)898)ELG4)Q0)
#>($) ,"0%$DB(J#.) @<) >"=<) B<=(<@<1) #><) J"#>?:J>&$(?7?I(D"7) B?7<) ?C) 898:;) "01) B<,0"0#)
7(J?JB?#<(0$)"#)D"B1(?="$D%7"B)<=<0#$)(0)R"J"0<$<)$%11<0)D"B1("D)1<"#>)ES;9G)D"$<$) EO"A7<)

-G.) <$J<D("77&) (0) S;9) D"$<$) @(#>) 0<"B7&) 0?B,"7) D?B?0"B&) "B#<B(<$) ED?B?0"B&) "#><B?$D7<B?$($)
IB"1<) E:G) "01) ETG.) 0",<7&) 6?''%B() 9<"#>) S&01B?,<) E69SG4) H$) #><) C?B,"#(?0) "01)
J>&$(?7?I(D"7)B?7<)?C)898)(0)7(=<B)"01)J7"$,")>"$)A<<0)@<77)<$#"A7($><1.)#>?$<)?C)B<,0"0#)
7(J?JB?#<(0$)EU86G)>"=<)"7$?)A<<0)<$#"A7($><1)B<D<0#7&)"$)")B($')C?B);F9)EV:WG4)H$)$>?@0)(0)
5(I%B<) ) OX:B(D>) 7(J?JB?#<(0) EOU8G) B<,0"0#$) "B<) C?B,<1) (0) #><) D(BD%7"#(?0) @><0) "J?Y:VZ)
D?0#"(0(0I)D>&7?,(DB?0$)E;2G)?C)(0#<$#(0"7)?B(I(0)?B)"J?Y:-MM)D?0#"(0(0I)[898)?C)><J"#(D)
?B(I(0) "B<) D?0=<B#<1) A&) 7(J?JB?#<(0) 7(J"$<) E"01) #?) ") 7<$$<B) <K#<0#) A&) ><J"#(D) 7(J"$<G) (0#?)
$,"77<B) "01) 1<0$<B) J"B#(D7<$) ?C) 8984) ;?,J"B<1) @(#>) #><(B) 0"$D<0#) JB<D%B$?B$.) OU8)
B<,0"0#$) "B<) 1<J7<#<1) ?C) #B(I7&D<B(1<$.) J>?$J>?7(J(1$.) "J?H:Q) "01) "J?H:Q[) (0) #><) D"$<) ?C)
;2)"01)"B<)<0B(D><1)(0)D>?7<$#<B&7)<$#<B$.)"J?;$)"01)"J?\)EWG4)O><&)D"0)#>%$)A<)(1<0#(C(<1.)
$<J"B"#<1.)?B)]%"0#(C(<1) (0)J7"$,")?0) #><)A"$($)?C) #><(B)1<0$(#&.)D>"BI<.)$(P<.) $J<D(C(D)7(J(1)
D?,J?0<0#$.) "J?7(J?JB?#<(0) D?,J?$(#(?0) "01) "J?7(J?JB?#<(0) (,,%0?$J<D(C(D(#&4) O>($)
$>?%71) ,<"0) #>"#) @<) >"=<) 0?@) #@?) (1<0#(C(<1)D"B1(?="$D%7"B)B($')C"D#?B$.)898)"01)U86)
E;2) B<,0"0#$) "01) [898) B<,0"0#$G) E5(I%B<) -G.) (0) S;9) "01) 69S) D"$<$) "01) "##<,J#<1) #?)
%01<B$#"01)#><)1(CC<B<0D<$)(0)#><(B)D?0#B(A%#(?0$)#?);F94))
U<D<0#) <=(1<0D<$) >"=<) $%II<$#<1) #>"#) <7<="#<1) J7"$,") 7<=<7$) ?C) B<,0"0#) 7(J?JB?#<(0) ^
D>?7<$#<B?7)EU86:;G)"01)B<1%D<1)7(J?JB?#<(0)7(J"$<)E868G)"D#(=(#&)B<7"#<)#?)#><)JB?,?#(?0)?C)
D?B?0"B&) "B#<B&) <=<0#$) "$$?D("#<1) @(#>) $J"$,) E_:`G.) @>(D>) >"$) A<<0) ?C#<0) ?A$<B=<1) "$) ")