Lipoprotein(a) as a Risk Factor for Cardiovascular Mortality in Type 2 Diabetic Patients
A 10-year follow-up study
- Cristina Hernández, MD1,
- Gemma Francisco, MD1,
- Pilar Chacón, MD2 and
- Rafael Simó, MD1
- 1Diabetes Research Unit, Endocrinology Division, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- 2Department of Biochemistry, Hospital Universitari Vall d’Hebron, Barcelona, Spain
- Address correspondence and reprint requests to Dr. Rafael Simó, Diabetes Research Unit, Endocrinology Division, Hospital Universitari Vall d’Hebron, Pg. Vall d’Hebron 119-129, 08035 Barcelona, Spain. E-mail: rsimo{at}vhebron.net
Although patients with type 2 diabetes have a high risk of death from cardiovascular disease (CVD), the traditional risk factors do not fully explain this excess of mortality. In this regard, it would be of great interest to assess the role of nontraditional risk factors such as lipoprotein(a) in cardiovascular mortality in diabetic patients.
Danesh et al. (1), in a meta-analysis including the prospective studies published before 2000, concluded that there was a clear association between lipoprotein(a) and CVD in the general population. Further prospective reports have demonstrated that lipoprotein(a) is an independent predictor of the development of CVD (2–5). However, little data exist on the clinical importance of lipoprotein(a) in the diabetic population. We herein report a prospective study to evaluate the relationship between lipoprotein(a) levels and cardiovascular mortality in type 2 diabetic patients of Caucasian origin.
RESEARCH DESIGN AND METHODS
One hundred twenty-two consecutive type 2 diabetic outpatients of Caucasian origin attending the outpatient diabetic unit of a university hospital between April and May of 1993 were enrolled for a 10-year prospective study. To avoid the possible transient increase of lipoprotein(a) after starting insulin treatment (6), all patients in whom insulin treatment was initiated in the months before the study were excluded. Patients with renal failure were also excluded. To assess evidence of macroangiopathy, we used the World Health Organization (WHO) protocol, which includes a detailed questionnaire and a 12-lead electrocardiogram (7,8). By the end of the study, data were available from 100 patients. Of these, 29 had died (23 from CVD).
Metabolic parameters …
