Lipoprotein(a), type 2 diabetes and vascular risk in coronary patients.
BACKGROUND
Lipoprotein(a) [Lp(a)] is an important cardiovascular risk factor in the general population. However, prospective data on the vascular risk conferred by Lp(a) in patients with diabetes mellitus are scarce and controversial. It is not known whether the diabetic state affects the association of Lp(a) with vascular events among coronary patients.


METHODS
We measured Lp(a) in 587 consecutive patients undergoing coronary angiography for the evaluation of coronary artery disease. The incidence of vascular events was recorded over 4 years.


RESULTS
At baseline, Lp(a) was significantly lower in patients with type 2 diabetes (T2DM) (n = 136) than in nondiabetic individuals (11 (0.8-30) mg dL(-1) vs. 16 (0.8-51) mg dL(-1); P = 0.025). Prospectively, Lp(a) was a strong and independent predictor of vascular events in nondiabetic patients (standardized adjusted hazard ratio (HR) = 1.461 (1.121-1.904); P = 0.005), but not in patients with T2DM [HR = 0.812 (0.539-1.223); P = 0.320]. An interaction term diabetes x Lp(a) was significant (P = 0.008), indicating that Lp(a) was a significantly stronger predictor of vascular events in nondiabetic patients than in patients with T2DM.


CONCLUSIONS
Lp(a) in diabetic coronary patients is low and not associated with the incidence of vascular events. Although measurement of Lp(a) provides useful information in nondiabetic coronary patients, it is of little value in coronary patients with T2DM.
Saely
C H
CH
Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria.
Koch
L
L
Schmid
F
F
Marte
T
T
Aczel
S
S
Langer
P
P
Hoefle
G
G
Drexel
H
H
D000368:Aged; D002784:Cholesterol / Q000097:blood; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000097:blood / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000188:drug therapy; D003925:Diabetic Angiopathies / Q000097:blood / Q000209:etiology*; D005260:Female; D006801:Humans; D007004:Hypoglycemic Agents / Q000627:therapeutic use; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors; D014280:Triglycerides / Q000097:blood; D014652:Vascular Diseases / Q000097:blood / Q000209:etiology*
D007004:Hypoglycemic Agents; D017270:Lipoprotein(a); D014280:Triglycerides; D002784:Cholesterol