Korean J Intern Med.  2016 Nov;31(6):1110-1119. 10.3904/kjim.2016.030.

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

• Lim TS
• Yun JS
• Cha SA
• Song KH
• Yoo KD
• Ahn YB
• Park YM
• Ko SH

• KMID: 2382861
• DOI: http://doi.org/10.3904/kjim.2016.030

Abstract

BACKGROUND/AIMS
Elevated 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.
METHODS
From 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.
RESULTS
Of 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]).
CONCLUSIONS
Elevated 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.

Keyword

Lipoprotein(a); Cardiovascular diseases; Diabetes mellitus, type 2

MeSH Terms

Cardiovascular Diseases*
Cohort Studies*
Confounding Factors (Epidemiology)
Coronary Artery Disease
Diabetes Mellitus, Type 2*
Follow-Up Studies
Humans
Hypertension
Insulin
Lipoprotein(a)*
Peptidyl-Dipeptidase A
Proportional Hazards Models
Prospective Studies*
Risk Factors
Stroke
Insulin
Lipoprotein(a)
Peptidyl-Dipeptidase A