Today, there is a fairly standard model of the factors leading to heart disease. Most heart disease is caused by growth of fatty deposits, known as atherosclerotic plaques, in coronary artery walls. Plaques narrow the width of arteries and lead to the formation of clots that can block the flow of blood, eventually causing a heart attack. Factors such as high blood pressure, smoking, and diabetes increase the risk of heart disease. High levels of cholesterol and saturated fats in the diet also increase the risk because they contribute to plaque formation.
A sizeable minority of coronary patients, however, experience heart attacks even though they display few or no standard risk factors. Recent research by Richard M. Lawn suggests that lipoprotein(a), a blood protein first isolated in the 1960s, may play a major role in such cases. Excessive levels of lipoprotein(a) are associated with strokes, heart attacks, and the narrowing of coronary arteries. In fact, males with high lipoprotein(a) levels account for about one quarter of male heart attack victims under the age of 60.
Lipoprotein(a) is closely related to low-density lipoprotein (LDL), a major contributor to atherosclerosis. As a group, lipoproteins absorb and transport fatty substances, including cholesterol, to various sites in the body. High-density lipoproteins, or HDLs, are protective and carry cholesterol to the liver for later use in the synthesis of important hormones; LDLs, however, deposit cholesterol in the bloodstream, including in coronary arteries, where it contributes to plaque formation. Lipoprotein(a) has almost the same complex structure as LDL, with an additional surface protein called apolipoprotein(a). Apolipoprotein(a) resembles plasminogen, a protein that binds with and dissolves fibrin, a key component of blood clots. Unlike plasminogen, however, apolipoprotein(a) does not dissolve fibrin.
A theory that would adequately explain how lipoprotein(a) operates has yet to be developed. But there is speculation that when too much lipoprotein(a) is present in the arteries, it may compete with plasminogen for access to fibrin in arterial blood clots. Since lipoprotein(a) cannot dissolve fibrin, the dissolution of clots is hampered, increasing the risk of arterial blockage. Another negative function has been suggested as well: lipoprotein(a), which enters blood vessel walls inside white blood cells known as macrophages, may prompt the release of growth factors by macrophages that thicken artery walls.
1. The passage is primarily concerned withA. discussing the possible role of lipoprotein(a) in some cases of heart disease
B. refuting the standard model of risk factors that may lead to heart disease
C. examining the evidence for two opposing theories about the function of lipoprotein(a)
D. suggesting ways that individuals prone to heart disease can reduce their risk
E. proposing that the structure of plasminogen is similar to the structure of apolipoprotein(a)
2. The author suggests which of the following about the "standard model" of the causes of heart disease?A. It misidentifies the most frequent causes of heart disease.
B. It has been undermined by research on lipoprotein(a).
C. It does not account for a significant number of heart disease cases.
D. It is no longer credible to most heart disease researchers.
E. It leads to errors in the treatment of heart disease patients.
3. According to the passage, research has shown that lipoprotein(a)
A. is more closely related to plasminogen than to low-density lipoprotein
B. functions in the same way as low-density lipoprotein
C. may decrease the risk of heart disease for some people
D. resembles low-density lipoprotein in structure
E. plays a role in preventing arterial blood clots
4. Which of the following, if true, would strengthen the theory that lipoprotein(a) contributes to heart disease?A. It aids in lowering the body's blood pressure.
B. It interferes with clot formation in coronary arteries.
C. It is more closely related to high-density lipoprotein than to low-density lipoprotein.
D. It assists in transporting cholesterol to the liver.
E. It causes the release of growth factors in blood vessels.