Lipoprotein (a) interactions with cholesterol-containing lipids on angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion

Abstract

Background We investigated whether or to what extent the interaction of lipoprotein (a) [Lp(a)] with cholesterol-containing lipids was associated with angiographic coronary collateralization in type 2 diabetic patients with chronic total occlusion. Methods Serum levels of Lp(a), total cholesterol, low-density lipoprotein–cholesterol (LDL-C), high-density lipoprotein–cholesterol (HDL-C), and triglyceride were determined and non-HDL-C was calculated in 706 type 2 diabetic and 578 non-diabetic patients with stable coronary artery disease and angiographic total occlusion of at least one major coronary artery. The degree of collaterals supplying the distal aspect of a total occlusion from the contra-lateral vessel was graded as poor (Rentrop score of 0 or 1) or good coronary collateralization (Rentrop score of 2 or 3). Results For diabetic and non-diabetic patients, Lp(a), total cholesterol, LDL-C, and non-HDL-C levels were higher in patients with poor coronary collateralization than in those with good collateralization, whereas HDL-C and triglyceride levels were similar. After adjustment for potential confounding factors, tertiles of Lp(a), total cholesterol, LDL-C and non-HDL-C remained independent determinants for poor collateralization. A significant interaction between Lp(a) and total cholesterol, LDL-C or non-HDL-C was observed in diabetic patients (all P interaction < 0.001) but not in non-diabetics. At high tertile of total cholesterol (≥ 5.35 mmol/L), LDL-C (≥ 3.36 mmol/L) and non-HDL-C (≥ 4.38 mmol/L), diabetic patients with high tertile of Lp(a) (≥ 30.23 mg/dL) had an increased risk of poor collateralization compared with those with low tertile of Lp(a) (< 12.66 mg/dL) (adjusted OR = 4.300, 3.970 and 4.386, respectively, all P < 0.001). Conclusions Increased Lp(a) confers greater risk for poor coronary collateralization when total cholesterol, LDL-C or non-HDL-C are elevated especially for patients with type 2 diabetes. Electronic supplementary material The online version of this article (10.1186/s12933-019-0888-z) contains supplementary material, which is available to authorized users.

Lipoprotein (a) predicts recurrent worse outcomes in type 2 diabetes mellitus patients with prior cardiovascular events: a prospective, observational cohort study

“…At the same time, among limited existing investigations related to patients with established CAD, inconsistent results were also observed. A recent cohort study support that in patients with stable CAD and chronic total occlusion, increased Lp(a) confers greater risk for poor coronary collateralization when TC, LDL-C or non-HDL-C are elevated especially in patients with T2DM [32]. In the previous study involving stable CAD patients with different glucose metabolism status, high Lp(a) were associated with significantly higher risk of subsequent CVEs in pre-DM and DM [15].…”

Long term clinical impact of successful recanalization of chronic total occlusion in patients with and without type 2 diabetes mellitus

“…[21,22] Dyslipidemia which is frequently associated with diabetes mellitus confers further greater risk for coronary collateralization. [23] Moreover, diabetes mellitus was associated with diffuse atherosclerosis of donor coronary arteries and further impaired collateral circulation over time. [24] These may be possible reasons behind the bene t after successful revascularization in diabetics.…”

Lipoprotein (a) Predicts Recurrent Worse Outcomes in Type 2 Diabetes Mellitus Patients with Prior Cardiovascular Events: A Prospective, Observational Cohort Study

“…At the same time, among limited existing investigations related to patients with established CAD, inconsistent results were also observed. A recent cohort study support that in patients with stable CAD and chronic total occlusion, increased Lp(a) confers greater risk for poor coronary collateralization when TC, LDL-C or non-HDL-C are elevated especially in patients with T2DM [33]. In the previous study involving stable CAD patients with different glucose metabolism status, high Lp(a) were associated with signi cantly higher risk of subsequent CVEs in pre-DM and DM [15].…”