Elevated lipoprotein(a) levels predict cardiovascular disease in type 2 diabetes mellitus: a 10-year prospective cohort study

Abstract

Background/AimsElevated lipoprotein(a) (Lp[a]) level is known to be a risk factor for cardiovascular disease (CVD). However, the data that has been reported on the association between the Lp(a) level and CVD in type 2 diabetes has been limited and incoherent. The aim of this study was to investigate the relationship between the Lp(a) concentration and new onset CVD in type 2 diabetes.MethodsFrom March 2003 to December 2004, patients with type 2 diabetes without a prior history of CVD were consecutively enrolled. CVD was defined as the occurrence of coronary artery disease or ischemic stroke. Cox proportional hazards models were used to identify the associations between the Lp(a) and CVD after adjusting for confounding variables.ResultsOf the 1,183 patients who were enrolled, 833 participants were evaluated with a median follow-up time of 11.1 years. A total of 202 participants were diagnosed with CVD (24.2%). The median Lp(a) level for 1st and 4th quartile group was 5.4 (3.5 to 7.1) and 55.7 mg/dL (43.1 to 75.3). Compared with patients without CVD, those with CVD were older, had a longer duration of diabetes and hypertension, and used more insulin and angiotensin converting enzyme inhibitors/angiotensin receptor blockers at baseline. A Cox hazard regression analysis revealed that the development of CVD was significantly associated with serum Lp(a) level (hazard ratio, 1.92; 95% confidence interval [CI], 1.26 to 2.92; p < 0.001, comparing the 4th vs. 1st quartile of Lp[a]).ConclusionsElevated Lp(a) level was an independent predictable risk factor for CVD in type 2 diabetes. Other cardiovascular risk factors should be treated more intensively in type 2 diabetic patients with high Lp(a) levels.

Lipoprotein(a): a not-so-well-known risk factor for the development of cardiovascular disease in patients with type 2 diabetes mellitus

“…In a cross-sectional survey of 14,516 apparently healthy Koreans, the 25th percentile, median, and 75th percentile Lp(a) levels were 9.4, 13.2, and 23.8 mg/dL, respectively [7]. These levels were similar to those in the study by Lim et al [6], of 8.3, 16.7, and 35.1 mg/dL, respectively, in Korean patients with T2DM. The hazard ratio for CVD development was 2.37 for the 4th versus the 1st Lp(a) quartile, and the median Lp(a) level in the 4th quartile was 55.7 mg/dL (range, 43.1 to 75.3).…”

“…However, in other studies, including that by Lim et al [6], Lp(a) levels in females were higher than those in males [6,12,13]. In the study by Lim et al [6], CVD developed more often in females. Therefore, the elevated CVD risk may be associated with the higher Lp(a) levels in females, although other risk factors, including age, need to be compared between males and females.…”

“…Some prospective studies found no significant sex-related difference in Lp(a) concentrations [10,11]. However, in other studies, including that by Lim et al [6], Lp(a) levels in females were higher than those in males [6,12,13]. In the study by Lim et al [6], CVD developed more often in females.…”

“…In this issue of the Korean Journal of Internal Medicine , Lim et al [6] report that an elevated Lp(a) level is an independent predictor of the development of CVD in Korean patients with type 2 diabetes mellitus (T2DM). This has high importance, as very limited information is available on the range of Lp(a) levels and the association of Lp(a) with CVD in Koreans.…”

Association Between Lipoprotein(a) and Risk Factors of Atherosclerosis in Russian Population (Data of Observational ESSE-RF study)

“…Association Between Lipoprotein(a) and Risk Factors of Atherosclerosis in Russian Population (Data of Observational ESSE-RF study) 7 Северо-Осетинская государственная медицинская академия. Россия, 362019, Владикавказ, ул.…”