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Lp(a) Levels & CVD Risk in Patients with Diabetes

Atherosclerosis; ePub 2018 Dec 29; Saeed, et al

In a biracial cohort of persons with diabetes mellitus or prediabetes, elevated lipoprotein(a) levels in Caucasian individuals were associated with further atherosclerotic cardiovascular disease (ASCVD) risk. Researchers measured lipoprotein(a) and other ASCVD risk factors at baseline (1996‒1998) in the biracial Atherosclerosis Risk in Communities study. Participants without prevalent ASCVD were monitored ~15 years for incident ASCVD events. Among the findings:

  • Of 9,871 eligible participants (mean age 63 years, 5,816 women, 2,155 African Americans), 1,543 had diabetes and 3,615 had prediabetes.
  • Cumulative ASCVD incidence rates were higher in those with diabetes (26%) or prediabetes (13%) than in nondiabetic individuals.
  • Increasing lipoprotein(a) levels were significantly associated with increasing incident ASCVD events in Caucasian participants with prediabetes and diabetes, but not those with normal fasting blood glucose.
  • Adding lipoprotein(a) to traditional risk factors improved ASCVD risk prediction.

Citation:

Saeed A, Sun W, Agarwala A, et al. Lipoprotein(a) levels and risk of cardiovascular disease events in individuals with diabetes mellitus or prediabetes: The Atherosclerosis Risk in Communities Study. [Published online ahead of print December 29, 2018]. Atherosclerosis. doi:10.1016/j.atherosclerosis.2018.12.022.

Commentary:

Lipoprotein(a) [Lp(a)] is an independent risk factor for ASCVD, especially in Caucasian populations. This study looked at a cohort of diabetic and prediabetic patients from the ARIC study and associated Lp(a) levels with ASCVD events over a 15-year period. As expected from other surveys, diabetic and prediabetic patients had a higher incidence of ASCVD events. The addition of increasing Lp(a) levels increased the incidence of events in these patients but not in patients with normal fasting blood glucose. This suggests that Lp(a) may become a more important factor in patients with additional cardiovascular risk. Lp(a) has both atherogenic and thrombogenic potential and may increase the risk for a myocardial infarction in patients with active coronary inflammation. Diabetes impact on endothelial function may allow Lp(a) to become a more active factor in the pathogenesis of vascular events. —Matthew Sorrentino, MD