title: Elevated Lipoprotein(a) has Incremental Prognostic Value in Type 2 Diabetic Patients with Symptomatic Coronary Artery Disease.
abstract: OBJECTIVE
  In addition to type 2 diabetes, an elevated Lp(a) level is known to be a surrogate biomarker of cardiovascular disease. However, recent studies have demonstrated that the Lp(a) levels are lower in type 2 diabetic patients than in non-diabetic subjects. Therefore, we sought to evaluate the prognostic value of elevated lipoprotein(a) [Lp(a)] in type 2 diabetic patients with symptomatic coronary artery disease (CAD).
  
  
  METHODS
  A total of 1494 diabetic patients with CAD (62.3% men, mean age: 63.5 ± 10.3 years) were enrolled. CAD was diagnosed using invasive coronary angiography, and laboratory values for lipid parameters, including Lp(a), were obtained on the day of coronary angiography. The patients were divided into tertile groups according to the individual Lp(a) level. The baseline characteristics, coronary angiographic findings, duration of follow-up and major adverse cardiovascular events (MACEs) were recorded.
  
  
  RESULTS
  Over a mean follow-up period of 4.4 ± 2.6 years, there were 59 MACEs (35 cardiac deaths and 24 cases of non-fatal myocardial infarction), for an event rate of 3.9%. A survival probability plot according to the Lp(a) tertile revealed that an elevated Lp(a) level was associated with a worse prognosis (p = 0.008), after adjusting for age, gender, hypertension, hyperlipidemia, smoking and the extent of CAD. Furthermore, the addition of an elevated Lp(a) level to the reference model improved the integrated discrimination improvement (0.0216, p ＜ 0.001), continuous net reclassification improvement (NRI) (0.5721, p = 0.012) and NRI (0.1549, p = 0.004) values.
  
  
  CONCLUSIONS
  In terms of the prognosis, elevated Lp(a) is associated with worse outcomes in type 2 diabetic patients with symptomatic CAD. Furthermore, an elevated Lp(a) level has incremental prognostic value in type 2 diabetic patients with symptomatic CAD.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Inha University Hospital, Incheon; Department of Medicine, Yonsei University Graduate School, Seoul, Republic of Korea.
authors.forename: Sung Woo
authors.initials: SW
authors.lastname: Kwon
authors.forename: Jong-Youn
authors.initials: JY
authors.lastname: Kim
authors.forename: Ji Min
authors.initials: JM
authors.lastname: Sung
authors.forename: Young Won
authors.initials: YW
authors.lastname: Yoon
authors.forename: Ji-Hyuck
authors.initials: JH
authors.lastname: Rhee
authors.forename: Byoung Kwon
authors.initials: BK
authors.lastname: Lee
authors.forename: Young-Hak
authors.initials: YH
authors.lastname: Jung
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Kim
authors.forename: Jung-Joon
authors.initials: JJ
authors.lastname: Cha
authors.forename: Jong-Kwan
authors.initials: JK
authors.lastname: Park
authors.forename: Eui-Young
authors.initials: EY
authors.lastname: Choi
authors.forename: Bum-Kee
authors.initials: BK
authors.lastname: Hong
authors.forename: Se-Joong
authors.initials: SJ
authors.lastname: Rim
authors.forename: Hyuck Moon
authors.initials: HM
authors.lastname: Kwon
mesh_terms: D000368:Aged; D003324:Coronary Artery Disease / Q000150:complications*; D003924:Diabetes Mellitus, Type 2 / Q000097:blood* / Q000150:complications; D005260:Female; D006801:Humans; D017270:Lipoprotein(a) / Q000097:blood*; D008297:Male; D008875:Middle Aged; D011379:Prognosis
chemical_list: D017270:Lipoprotein(a)