Severity of diabetic retinopathy is linked to lipoprotein (a) in type 1 diabetic patients

To determine the relationship between plasma Lp(a) concentration and the ri sk of developing diabetic retinopathy, 341 Type 1 diabetic patients underwe nt an annual retinal fluorescein angiography and were assigned to one of 3 groups according to the stage of their diabetic retinopathy: no retinopathy (NR), non-proliferative diabetic retinopathy (N-PDR), or proliferative dia betic retinopathy (POR). One hundred and twenty-three Type 1 diabetic patie nts had no retinopathy, 188 had N-PDR and 30 had PDR. The ages of the three groups and the duration of diabetes were significantly different. Hyperten sion, microalbuminuria and diabetic nephropathy were more frequent in FOR t han in NR or N-PDR (p < 0.0001). Plasma HbA1c was higher in PDR than in NR or N-PDR (p < 0.01). Type 1 patients who had been diabetic far at least 20 years included 30 NR, 108 N-PDR and 24 PDR. Type 1 diabetic patients with P DR had microalbuminuria and macroproteinuria more frequently than other pat ients (p < 0.0001 and 0.01, respectively). Type I diabetic patients with PD R had the highest median plasma Lp(a) and the highest frequency of Lp(a) ab ove SO mg/dl(p < 0.05). Multivariate analysis carried out in Type 1 diabeti c patients with a duration of diabetes of at least 20 years showed that mic roproteinuria, HbA1c and Lp(a) accounted significantly for 21% of variance in retinal status. Lp(a) above 30 mg/dl was related to the risk of developi ng FOR (OR = 8.40, p < 0.05). Lipoprotein(a) appears to be associated with the severity of diabetic retinopathy in Type 1 diabetic patients, and parti cular attention should be paid to those with Lp(a) above 30 mg/dl and pre-p roliferative retinopathy.