Korean Diabetes J.  2009 Dec;33(6):485-493. 10.4093/kdj.2009.33.6.485.

The Relationship Between Coronary Artery Calcification and Serum Apolipoprotein A-1 in Patients with Type 2 Diabetes

• Seo HA
• Choi YK
• Jeon JH
• Lee JE
• Jeong JY
• Moon SS
• Lee IK
• Kim BW
• Kim JG

• KMID: 2298054
• DOI: http://doi.org/10.4093/kdj.2009.33.6.485

Abstract

BACKGROUND
The incidence of type 2 diabetes mellitus is increasing annually and patient mortality is high. Coronary artery calcification is a predictor of coronary artery disease. Cardiovascular events, which are the main cause of death in type 2 diabetes patients, may be preventable by addressing risk factors associated with coronary artery calcification. We examined the relationships between coronary artery calcification, lipid profiles, and apolipoprotein levels. METHODS: We calculated the coronary calcium scores (CCS) of 254 subjects with type 2 diabetes (113 males, 141 females) via multi-detector row computed tomography (MDCT). Height, body weight, blood pressure, HbA1c, c-peptide, lipid profile and apolipoprotein were assessed concurrently. RESULTS: In patients with type 2 diabetes, Agatston score and apolipoprotein A-1 were significantly negatively correlated in both males and females (males P = 0.015, females P = 0.021). The negative correlation between Agatston score and apolipoprotein A-1 was retained for the entire patient sample after adjustments for age and sex (P = 0.022). Stepwise multiple regression anaylses with the Agatston score as the dependent variable indicate that apolipoprotein A-1 is a independent predictor (beta coefficient = -0.047, 95%CI = -0.072 ~ -0.021, P < 0.001) of coronary artery calcification. CONCLUSION: The results of our study suggest that apolipoprotein A-1 is a useful independent indicator of coronary artery calcification.

Keyword

Apolipoproteins; Atherosclerosis; Cardiovascular diseases; Lipids; Type 2 diabetes mellitus

MeSH Terms

Apolipoprotein A-I
Apolipoproteins
Atherosclerosis
Blood Pressure
Body Height
C-Peptide
Calcium
Cardiovascular Diseases
Cause of Death
Coronary Artery Disease
Coronary Vessels
Diabetes Mellitus, Type 2
Female
Humans
Incidence
Male
Risk Factors
Apolipoprotein A-I
Apolipoproteins
C-Peptide
Calcium

Figure

• 

  Fig. 1 Negative correlation was seen between Ln (Agatston + 1) and serum apolipoprotein A-1 in females (LnAgatston = Ln (Agatston + 1)).

• 

  Fig. 2 Negative correlation was seen between Ln (Agatston + 1) and serum apolipoprotein A-1 in males (LnAgatston = Ln (Agatston + 1)).

Reference

1. Kim SG, Choi DS. The present state of diabetes mellitus in Korea. J Korean Med Assoc. 2008. 51:791–798.

2. Maciejewski ML, Maynard C. Diabetes-related utilization and costs for inpatient and outpatient services in the Veterans Administration. Diabetes Care. 2004. 27:suppl 2. B69–B73.

3. Hogan P, Dall T, Nikolov P. Economic costs of diabetes in the US in 2002. Diabetes Care. 2003. 26:917–932.

4. Park SK, Park MK, Suk JH, Kim MK, Kim YK, Kim IJ, Kang YH, Lee KJ, Lee HS, Lee CW, Kim BH, Lee KI, Kim MK, Kim DK. Cause-of-death trends for diabetes mellitus over 10 years. Korean Diabetes J. 2009. 33:65–72.

5. Kannel WB, McGee DL. Diabetes and cardiovascular disease. The Framingham study. JAMA. 1979. 241:2035–2038.

6. Wexler L, Brundage B, Crouse J, Detrano R, Fuster V, Maddahi J, Rumberger J, Stanford W, White R, Taubert K. Coronary artery calcification: pathophysiology, epidemiology, imaging methods, and clinical implications. A statement for health professionals from the American Heart Association. Writing Group. Circulation. 1996. 94:1175–1192.

7. Stary HC. The sequence of cell and matrix changes in atherosclerotic lesions of coronary arteries in the first forty years of life. Eur Heart J. 1990. 11:suppl E. 3–19.

8. McCullough PA. Effect of lipid modification on progression of coronary calcification. J Am Soc Nephrol. 2005. 16:suppl 2. S115–S119.

9. Doherty TM, Detrano RC. Coronary arterial calcification as an active process: a new perspective on an old problem. Calcif Tissue Int. 1994. 54:224–230.

10. LaMonte MJ, FitzGerald SJ, Church TS, Barlow CE, Radford NB, Levine BD, Pippin JJ, Gibbons LW, Blair SN, Nichaman MZ. Coronary artery calcium score and coronary heart disease events in a large cohort of asymptomatic men and womem. Am J Epidemiol. 2005. 162:421–429.

11. Weintraub WS, Diamond GA. Predicting cardiovascular events with coronary calcium scoring. N Engl J Med. 2008. 358:1394–1396.

12. Gaudio C, Mirabelli F, Pelliccia F, Francone M, Tanzilli G, Michele SD, Leonetti S, Vincentis GD, Carbone I, Mangieri E, Catalano C. Early detection of coronary artery disease by 64-slice multidetector computed tomography in asymptomatic hypertensive high-risk patients. Int J Cardiol. 2009. 135:280–286.

13. Oudkerk M, Stillman AE, Halliburton SS, Kalender WA, Mohlenkamp S, McCollough CH, Vliegenthart R, Shaw LJ, Stanford W, Taylor AJ, Van Ooijen PM, Wexler L, Raggi P. Coronary artery calcium screening: current status and recommendations from the European Society of Cardiac Radiology and North American Society for Cardiovascular Imaging. Eur Radiol. 2008. 18:2785–2807.

14. Sabour S, Atsma F, Rutten A, Grobbee DE, Mali W, Prokop M, Bots ML. Multi Detector-Row Computed Tomography (MDCT) had excellent reproducibility of coronary calcium measurements. J Clin Epidemiol. 2008. 61:572–579.

15. Hall EF. Commentary: Use of EBCT in epidemiological studies: the effect of noise and body size on coronary calcium scores. Int J Epidemiol. 2005. 34:179–180.

16. Schlosser T, Hunold P, Schmermund A, Kuhl H, Waltering KU, Debatin JF, Barkhausen J. Coronary artery calcium score: influence of reconstruction interval at 16-detector row CT with retrospective electrocardiographic gating. Radiology. 2004. 233:586–589.

17. Hoff JA, Chomka EV, Krainik AJ, Daviglus M, Rich S, Kondos GT. Age and gender distributions of coronary artery calcium detected by electron beam tomography in 35,246 adults. Am J Cardiol. 2001. 87:1335–1339.

18. Halliburton SS, Stillman AE, White RD. Noninvasive quantification of coronary artery calcification: methods and prognostic value. Cleve Clin J Med. 2002. 69:suppl 3. S6–S11.

19. Shoulders CC, Kornblihtt AR, Munro BS, Baralle FE. Gene structure of human apolipoprotein A1. Nucleic Acids Res. 1983. 11:2827–2837.

20. Atzmon G, Gabriely I, Greiner W, Davidson D, Schechter C, Barzilai N. Plasma HDL levels highly correlate with cognitive function in exceptional longevity. J Gerontol A Biol Sci Med Sci. 2002. 57:M712–M715.

21. Yui Y, Aoyama T, Morishita H, Takahashi M, Takatsu Y, Kawai C. Serum prostacyclin stabilizing factor is identical to apolipoprotein A-I (Apo A-I). A novel function of Apo A-I. J Clin Invet. 1988. 82:803–807.

22. Chumakova OS, Zateishchikov DA, Sidorenko BA. Apolipoprotein B: structure, function, gene polymorphism, and relation to atherosclerosis. Kardiologiia. 2005. 45:43–55.

23. Sun H, Unoki H, Wang X, Liang J, Ichikawa T, Arai Y, Shiomi M, Marcovina SM, Watanabe T, Fan J. Lipoprotein(a) enhances advanced atherosclerosis and vascular calcification in WHHL transgenic rabbits expressing human apolipoprotein(a). J Biol Chem. 2002. 277:47486–47492.

24. American Diabetes Association. Diagnosis and classification of diabetes mellitus. Diabetes Care. 2009. 32:suppl 1. S62–S67.

25. Rumberger JA, Simons DB, Fitzpatrick LA, Sheedy PF, Schwartz RS. Coronary artery calcium area by electron-beam computed tomography and coronary atherosclerotic plaque area. A histopathologic correlative study. Circulation. 1995. 92:2157–2162.

26. Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, Schwartz RS. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol. 1998. 31:126–133.

27. Mazzone T, Meyer PM, Kondos GT, Davidson MH, Feinstein SB, D'Agostino RB Sr, Perez A, Haffner SM. Relationship of traditional and nontraditional cardiovascular risk factors to coronary artery calcium in type 2 Diabetes. Diabetes. 2007. 56:849–855.

28. Detrano R, Guerci AD, Carr JJ, Bild DE, Bruke G, Folsom AR, Liu K, Shea S, Szklo M, Bluemke DA, O'Leary DH, Tracy R, Watson K, Wong ND, Kronmal RA. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med. 2008. 358:1336–1345.

29. Gerrior J, Tang A, Fauntleroy J, Hendricks K, Mangili A, Schaefer E, Gorbach S, Wanke C. Predictors of abnormal coronary calcification at 3 years in the nutrition for healthy living cohort study. Conf Retrovir Opportunistic Infect. 2006. 13:5–8.