Issue 161 Item 6 ADA: Lipoprotein(a) Associated with Cardiovascular Mortality in

There appears to be an independent association between lipoprotein a and cardiovascular mortality in patients with type 2 diabetes, researchers reported at the American Diabetes Association 63rd Annual Meeting.

“This is the first research to provide initial evidence for this independent association,” said investigator Cristina Hernandez, MD, of the diabetes unit, division of endocrinology, Hospital General Universitari Vall d’Hebron, in Barcelona, Spain.

Between April and May of 1993, Dr. Hernandez and colleagues enrolled and tracked data on 122 consecutive patients with type 2 diabetes attending an outpatient diabetic unit in Barcelona. These patients were participating in a larger 9-year prospective study.

Besides lipoprotein a, the investigators followed changes in age, gender, body mass index (BMI), cigarette smoking, blood pressure, hemoglobin A1c (HbA1c), serum cholesterol concentration, albumin excretion rate, and serum creatinine levels.

At end point the investigators analyzed data from 99 remaining subjects, using stepwise multiple logistic regression to determine cardiovascular mortality as an dependent variable from other variables.

They measured lipoprotein a by enzyme-linked immunosorbent assay (ELISA) and log-transformed the data before their statistical analysis, in order to achieve a normal distribution.

They reported that during follow-up, 29.3% of subjects died, with 21.2% of deaths due to cardiovascular causes.

“The [lipoprotein(a)] concentration was higher in patients who died from cardiovascular disease [15.5 mg/dL] in comparison with those who remain alive [7 mg/dL] or those who died from non-cardiovascular disease [3.7 mg/dL],” the researchers stated.

The stepwise multivariate logistic regression analysis indicated that lipoprotein a is an independent risk factor for cardiovascular mortality (RR 3.57, 95% CI: 1.01 to 12.6; P=0.04).

“This represents a beginning — a powerful one — in the study of this independent connection and of its clinical implications,” Dr. Hernandez added.

[Study title: Lipoprotein as a Risk Factor for Cardiovascular Mortality in Type 2 Diabetic Patients: A 9-year Follow- up Study. Abstract 667]