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Potential New Cardiovascular Risk Factors: Left Ventricular Hypertrophy, Homocysteine, Lipoprotein(a), Triglycerides, Oxidative Stress, and Fibrinogen

Kishore J. Harjai, MBBS
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From the Ochsner Clinic, New Orleans, Louisiana.


Current Author Address: Kishore J. Harjai, MBBS, Department of Cardiology, Ochsner Clinic, 1514 Jefferson Highway, New Orleans, LA 70121; e-mail, kharjai@ochsner.org.


Ann Intern Med. 1999;131(5):376-386. doi:10.7326/0003-4819-131-5-199909070-00009
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The 1996 Bethesda Conference acknowledged left ventricular hypertrophy, hyperhomocysteinemia, lipoprotein(a) excess, hypertriglyceridemia, oxidative stress, and hyperfibrinogenemia as possible new cardiac risk factors. This review summarizes the current literature that supports these conditions as cardiac risk factors. Left ventricular hypertrophy is an independent risk factor for vascular disease. Improvement or progression of left ventricular hypertrophy influences subsequent cardiovascular complications. Clinical trials are under way to assess the potential benefit of decreasing homocysteine levels. The role of lipoprotein(a) excess in vascular disease is controversial. The atherogenic potential of lipoprotein(a) seems to be neutralized by effective reduction of low-density lipoprotein cholesterol levels. Increasing evidence supports an independent role of hypertriglyceridemia in cardiovascular disease and a possible clinical benefit from decreasing triglyceride levels. Among antioxidant micronutrients, supplementation with vitamin E has been shown to be beneficial in primary and secondary prevention studies. Data supporting the use of other antioxidants are much weaker. Preliminary evidence suggests that reducing fibrinogen levels in patients with high baseline levels and coronary disease may be beneficial. Despite the potential relation between new risk factors and cardiovascular disease, routine clinical application of these conditions as cardiovascular risk factors would be premature. Evidence is needed that these conditions extend prognostic ability beyond conventional risk factors and that modification of these conditions can reduce the risk for cardiovascular events.

Figures

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Figure.
Geometric patterns of left ventricular hypertrophy.P(18)

* = 0.001 compared with normal persons. LV = left ventricle; LVH = left ventricular hypertrophy; LVMI = left ventricular mass index, calculated as left ventricular mass divided by body surface area; RWT = relative wall thickness. Reprinted with permission from the American College of Cardiology .

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