Environmental and behavioral influences on plasma lipoprotein(a) concentration in women twins

Background. Genetic factors are firmly established as determinants of plasma lipoprotein(a) [Lp(a)] concentration. This study focused on behavioral or environmental factors that might also explain some of the variation in levels of this cardiovascular disease risk factor. Methods. The study considers the 644 women twins (597 whites, 47 blacks; ages 30-91 years) who participated in the second examination of the Kaiser Permanente Women Twins Study. Cross-sectional associations of behaviors and environmental factors with Lp(a) concentration were studied before and after removing genetic influences on Lp(a) levels. Results. Lp(a) levels were substantially higher among blacks than whites (P < 0.0001). The distribution of apo(a) size phenotypes also differed between blacks and whites, but this variation did not explain the difference in Lp(a) levels. A positive association of Lp(a) concentration with age was noted among blacks (P = 0.06) but not among whites (P = 0.86). No evidence was found for associations of Lp(a) with menopausal status, cigarette smoking, alcohol consumption, total or heavy recreational physical activity, 11-year weight gain, use of several antihypertensive medications, or diabetes status in either race. Among postmenopausal women, however, estrogen replacement therapy was associated with lower Lp(a) levels among whites (7.9 vs 9.9 mg/dl, P = 0.05). Removing genetic variation in Lp(a) concentration by matching 171 monozygotic (MZ) twins to their genetically identical co-twins did not alter these findings. Conclusion. The plasma concentration of Lp(a), unlike other lipoprotein risk factors for heart disease, has few behavioral or environmental correlates, at least among white women. Neither behavioral or environmental factors nor variation in the apo(a) size phenotype appeared to explain the higher mean Lp(a) levels among black compared with white women; further study seems warranted in larger samples of black women.