Influence of lipoprotein(a) on restenosis after femoropopliteal percutaneous transluminal angioplasty in Type 2 diabetic patients.
OBJECTIVE
The influence of vascular morphology and metabolic parameters including lipoprotein(a) (Lp(a)) on restenosis after peripheral angioplasty has been compared in Type 2 diabetes (DM) vs. non-diabetic patients (ND).


METHODS
The clinical course and risk profile of 132 (54 DM vs. 78 ND) patients with peripheral arterial occlusive disease (PAD) were observed prospectively following femoropopliteal angioplasty (PTA). Clinical examination, oscillometry, ankle brachial blood pressure index (ABI) and the toe systolic blood pressure index (TSPI) were used during follow-up. Duplex sonography and reangiography were also used to verify suspected restenosis or reocclusion.


RESULTS
At the time of intervention patients with DM had a lower median Lp(a) of 9 vs. 15 mg/dl (P < 0.01) in patients without diabetes. Recurrence within 1 year after PTA occurred in 25 diabetic (= 46%, Lp(a) 12 mg/dl) and 30 non-diabetic (= 38%, Lp(a) 48 mg/dl) patients. DM patients with 1 year's patency had a median Lp(a) of 7 vs. 11 mg/dl in non-diabetic patients (P < 0.05). However, 12 months after angioplasty Lp(a) correlated negatively with the ABI (r = -0.44, P < 0.01) in diabetic and in non-diabetic patients (r = -0.20, P < 0.05). The probability of recurrence after PTA continuously increased with higher levels of Lp(a) in each subgroup of patients.


CONCLUSIONS
Our data indicate that Lp(a) is generally lower in those with peripheral arterial occlusive disease and Type 2 diabetes than in non-diabetic individuals. The increased risk for restenosis with rising levels of Lp(a) is set at a lower Lp(a) in diabetes and may be more harmful for diabetic patients.
Maca
T H
TH
Departments of Medical Angiology, Nephrology and Medical Statistics, University of Vienna, Vienna, Austria. Thomas.Maca@AKH-Wien.ac.at
Ahmadi
R
R
Derfler
K
K
Ehringer
H
H
Gschwandtner
M E
ME
Hörl
W
W
Katzenschlager
R
R
Müller-Knespel
E
E
Koppensteiner
R
R
Schneider
B
B
Stümpflen
A
A
Ugurluoglu
A
A
Minar
E
E
D000368:Aged; D015906:Angioplasty, Balloon, Coronary; D015415:Biomarkers / Q000097:blood; D001786:Blood Glucose / Q000378:metabolism; D002784:Cholesterol / Q000097:blood; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology*; D003925:Diabetic Angiopathies / Q000503:physiopathology / Q000628:therapy*; D005260:Female; D005268:Femoral Vein / Q000601:surgery*; D006083:Graft Occlusion, Vascular / Q000453:epidemiology*; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008074:Lipoproteins / Q000097:blood; D008297:Male; D008875:Middle Aged; D011150:Popliteal Artery / Q000601:surgery*; D016896:Treatment Outcome; D014280:Triglycerides / Q000097:blood
D015415:Biomarkers; D001786:Blood Glucose; D017270:Lipoprotein(a); D008074:Lipoproteins; D014280:Triglycerides; D002784:Cholesterol