Abstract
BACKGROUND: Diabetes mellitus (DM) and Lp(a) are well-established predictors of coronary artery disease (CAD) outcomes. However, their combined association remains poorly understood.
OBJECTIVE: To investigate the relationship between elevated Lp(a) and DM with CAD outcomes.
METHODS: Retrospective analysis of the MGB Lp(a) Registry involving patients ≥ 18 years who underwent Lp(a) measurements between 2000 and 2019. Exclusion criteria were severe kidney dysfunction, malignant neoplasms, and prior atherosclerotic cardiovascular disease (ASCVD). The primary outcome was a combination of cardiovascular death or myocardial infarction (MI). Elevated Lp(a) was defined as > 90th percentile (≥ 216 nmol/L).
RESULTS: Among 6,238 patients who met the eligibility criteria, the median age was 54, 45% were women, and 12% had DM. Patients with DM were older, more frequently male, and had a higher prevalence of additional cardiovascular risk factors. Over a median follow-up of 12.9 years, patients with either DM or elevated Lp(a) experienced higher rates of the primary outcome. Notably, those with elevated Lp(a) had a higher incidence of the primary outcome regardless of their DM status. The annual event rates were as follows: No-DM and Lp(a) < 90th% - 0.6%; No-DM and Lp(a) > 90th% - 1.3%; DM and Lp(a) < 90th% - 1.9%; DM and Lp(a) > 90th% - 4.7% (p < 0.001). After adjusting for confounders, elevated Lp(a) remained independently associated with the primary outcome among both patients with DM (HR = 2.66 [95%CI: 1.55-4.58], p < 0.001) and those without DM (HR = 2.01 [95%CI: 1.48-2.74], p < 0.001).
CONCLUSIONS: Elevated Lp(a) constitutes an independent and incremental risk factor for CAD outcomes in patients with and without DM.
Original language | English (US) |
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Article number | 257 |
Pages (from-to) | 257 |
Journal | Cardiovascular Diabetology |
Volume | 23 |
Issue number | 1 |
DOIs | |
State | Published - Jul 18 2024 |
Keywords
- Coronary artery disease outcomes
- Diabetes mellitus
- Lipoprotein (a)
- Up-Regulation
- Myocardial Infarction/epidemiology
- Diabetes Mellitus/epidemiology
- Prognosis
- Prevalence
- Risk Assessment
- Humans
- Middle Aged
- Male
- Lipoprotein(a)/blood
- Incidence
- Time Factors
- Female
- Registries
- Biomarkers/blood
- Adult
- Retrospective Studies
- Heart Disease Risk Factors
- Aged
- Coronary Artery Disease/blood
ASJC Scopus subject areas
- Internal Medicine
- Endocrinology, Diabetes and Metabolism
- Cardiology and Cardiovascular Medicine