Serum lipoprotein(a) concentration as a cardiovascular risk factor in Kuwaiti Type 2 diabetic patients

Serum lipoprotein(a) [Lp(a)], a risk factor for coronary heart disease (CHI D) in some nondiabetic populations, is largely under genetic control and va ries among ethnic and racial groups. We evaluated serum Lp(a) concentration and its relationship with traditional CHD fisk factors (age, sex, smoking, hypertension, dyslipidemia) as well as stage of diabetic nephropathy in 34 5 type 2 diabetic patients. Lp(a) concentration was skewed with median (2.5 th, 97.5th percentiles) of 25.0 (8.1, 75.7) mg/dl. Twenty-three of 55 (41.8 %) patients with CHD had increased (>30 mg/dl) Lp(a) compared with 102 of 2 90 (35.1%) patients without CHID ( P=.35). Twelve of 27 (44.4%) female pati ents with CHD had increased Lp(a) compared to 11 of 28 (39.3%) males ( P=.7 0). Lp(a) was significantly (P<.05) higher in females than males, but the l ogistic regression analysis showed significant association of Lp(a), LDL-C, and duration of diabetes mellitus (DM) vith CHD in male patients only. Alt hough female patients with CHD and macroalbuminuria had significantly (P<.0 5) higher Lp(a) than normoalbuminuric female patients without CHD, no such association was found in males and no significant association was found bet ween Lp(a) and the degree of albuminuria. Partial correlation analysis cont rolling for age, sex, and BMI showed significant correlation of Lp(a) with total cholesterol only (P=.03) and no correlation was found with other lipi d parameters. Multiple regression analysis did not show significant associa tions of Lp(a) with standard CHD risk factors, HbA(1c), and plasma creatini ne. This study is in agreement with studies in other populations, which sho wed that Lp(a) may not be an independent risk factor for CHD in patients wi th DM. However, as Lp(a) could promote atherogenesis via several mechanisms , follow-up studies in our patients will confirm if increased Lp(a) concent ration can partly account for the poorer prognosis when diabetic patients d evelop CHID. (C) 2001 Elsevier Science Inc. All rights reserved.