Peripheral atherosclerosis and serum lipoprotein(a) in diabetes

OBJECTIVE - Serum lipoprotein(a) [Lp(a)] is strongly associated with athero sclerosis in nondiabetic individuals. To see if atherosclerosis is also ass ociated with serum Lp(a) in both IDDM and NIDDM, we determined the correlat ion between the toe systolic blood pressure index (TSPI) and serum Lp(a) in tightly controlled diabetic patients without nephropathy. RESEARCH DESIGN AND METHODS - Cross-sectional study of 57 IDDM and 35 NIDDM patients. All patients had been under strict glycemic control for at least 6 months. The main outcome measure was TSPI of both lower extremities. In addition, we measured serum Lp(a) and other serum lipids, serum uric acid, total plasma homocysteine, plasma C-peptide, HbA(1c), albumin excretion rat e, glomerular filtration rate, BMI, abdominal fat distribution, left ventri cular hypertrophy, probabilities for cardiovascular disease (CVD), and rout ine clinical parameters. RESULTS - TSPI was closely and independently related to serum Lp(a) in IDDM patients: R-2 = 0.2999, partial P = 0.0005, and in NIDDM patients. R-2 = 0 .7326, partial P = 0.0030. TSPI was associated with symptoms of CVD. Median serum Lp(a) concentration was normal in IDDM (45 mg/l [range 10-870]) and NIDDM (72 mg/l [11-803]) patients. CONCLUSIONS - Systemic atherosclerosis measured as the degree of peripheral occlusive arterial disease is strongly associated with serum Lp(a) in both IDDM and NIDDM patients. Serum Lp(a), however, is normal in both types of diabetic patients. Thus, it is indicated that serum Lp(a) should be measure d in diabetic patients when assessing their risk profile for atherosclerosi s.