Association of elevated lipoprotein(a) levels and coronary heart disease in NIDDM patients. Relationship with apolipoprotein(a) phenotypes

Abstract

Summary Non-insulin-dependent diabetes mellitus (NIDDM) is a strong and independent risk factor for coronary heart disease. We assessed the potential relationship between plasma Lp(a) levels, apo(a) phenotypes and coronary heart disease in a population of NIDDM patients. Seventy-one patients with coronary heart disease, who previously have had transmural myocardial infarction, or significant stenosis on coronary angiography, or positive myocardial thallium scintigraphy, or in combination, were compared with 67 patients without coronary heart disease, who tested negatively upon either coronary angiography, myocardial thallium scintigraphy or a maximal exercise test. The prevalence of plasma Lp(a) levels elevated above the threshold for increased cardiovascular risk ( > 0.30 g/l) was significantly higher (p = 0.005) in patients with coronary heart disease (33.8 %) compared to the control group (13.4%). The relative risk (odds ratio) of coronary heart disease among patients with high Lp(a) concentrations was 3.1 (95 % confidence interval, 1.31-7.34;p = 0.01). The overall frequency distribution of apo(a) phenotypes differed significantly between the two groups (p = 0.043). However, the frequency of apo(a) isoforms of low apparent molecular mass ( < 700 kDa) was of borderline significance (p = 0.067) between patients with or without coronary heart disease (29.6 % and 16.4 %, respectively). In this Caucasian population of NIDDM patients, elevated Lp(a) levels were associated with coronary heart disease, an association which was partially accounted for by the higher frequency of apo(a) isoforms of small size. In multivariate analyses, elevated levels of Lp(a) were independently associated with coronary heart disease (odds ratio 3.48, p = 0.0233). [Diabetologia (1994) 37: 585-591] Key words NIDDM, lipoprotein(a), apo(a) isoforms, coronary heart disease, lipids, lipoproteins, cardiovascular risk factors.Non-insulin-dependent diabetes mellitus (NIDDM) is a strong and independent risk factor for cardiovascular and coronary heart disease mortality [1]. Established risk factors, including glucose intolerance, arterial hypertension, central obesity, hypercholesterolaemia or hypertriglyceridaemia, have been shown to contrib-

Relationship between lipoprotein(a) phenotypes and albumin excretion rate in non‐insulin‐dependent diabetes mellitus: protective effect of ‘null’ phenotype?

“…At present, a consensus for grouping the Lp(a) phenotypes does not exist, but it would be desirable in order to facilitate statistical management of the data. Therefore, we have grouped phenotypes by size as 'small' (F, B, S1 and S2), 'big' (S3 and S4) and 'null', as reported previously by others authors [11,44]. The clear statistically significant difference in Lp(a) serum concentration demonstrated among the three groups observed in our study reinforced this classification.…”

“…Lp(a) is an independent risk factor for CVD [7][8][9] and seems to be related to the severity of this disease in angiographic studies [27,28]. However, the role of Lp(a) in the development of atherosclerosis in NIDDM patients is less clear [10][11][12][13].…”

“…Thus, it could be speculated that Lp(a) is involved in the excess of cardiovascular morbidity and mortality observed in diabetic patients with microalbuminuria. However, in diabetic patients, the relationship between Lp(a) and CVD is less clear [10][11][12][13] and the results of studies that attempt to find an association between Lp(a) and microalbuminuria are conflicting [14][15][16][17][18][19][20]. It is possible that these discrepancies could be caused by different criteria used for the selection of patients, size of the population sample, study design and the statistical treatment of the results.…”

Four‐year prospective study of the influence of elevated serum lipoprotein (a) concentration on ischemic heart disease and cerebral infarction in elderly patients with type‐2 diabetes

“…Asymptomatic IHD is known to be more common in diabetic than in non-diabetic patients. 23 Most studies have not addressed this problem, [1][2][3][4][5][6][7][8][9][10]20,21,24 but asymptomatic IHD was considered in the study by Ruiz et al 25 They tested type-2 diabetic subjects for IHD, including asymptomatic cases, using either exercise electrocardiography, dipyridamole myocardial thallium scintigraphy or coronary angiography, and showed that an elevated Lp(a) concentration is a risk factor for this condition. It is often difficult to perform exercise stress testing or coronary angiography on elderly patients, but there is a need for future studies that include testing for asymptomatic IHD, perhaps using minimally invasive tests such as myocardial scintigraphy.…”

Determination and Evaluation of Serum Lipid Profile, Creatinine and Glycated hemoglobin (HbA1c %) in Sudanese Patients with Type 2 Diabetes Mellitus Associated with Obesity

“…These patients often have abnormalities of both quantity and quality of lipoproteins that, among other factors, might be responsible for the increased incidence of vascular complications. Several studies were conducted to find out the lipid abnormalities in diabetes mellitus and to ascertain the effect of anti-diabetic treatment on these abnormalities [4].…”