Elevated lipoprotein(a) in type 1 diabetes heightens CV risk
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Adults with type 1 diabetes may be more likely to develop macrovascular complications, albuminuria and calcified aortic valve disease if they have elevated measures of lipoprotein(a), according to findings published in Diabetes Care.
“Patients with type 1 diabetes mellitus have an increased risk for cardiovascular disease,” Karin Littmann, MD, a PhD student in the department of laboratory medicine at Karolinska Institutet in Solna, Sweden, told Healio. “Little is known about the importance of lipoprotein(a) for the cardiovascular risk in these patients, and this study contributes to further knowledge within this field.”
Littmann and colleagues assessed data from 1,860 adults with type 1 diabetes (mean age, 48 years; 44% women) as part of an observational cross-sectional registry study. The researchers collected participant data on lipoprotein(a), HbA1c, creatinine, cholesterol, HDL cholesterol, LDL cholesterol, triglycerides, estimated glomerular filtration rate and urine albumin-to-creatinine ratio using blood and urine samples. The researchers also used electronic medical records from Karolinska University Hospital to identify instances of coronary heart disease, cerebrovascular disease, aortic stenosis, retinopathy, albuminuria, peripheral neuropathy and diabetic foot disease. Composite CVD, which included coronary heart disease and cerebrovascular disease, was used to estimate overall macrovascular disease.
The relative risk ratio of composite CVD was 1.51 times greater for those with more than 120 nmol/L or what the researchers categorized as high levels of lipoprotein(a) vs. those with less than 10 nmol/L or what the researchers categorized as very low levels of lipoprotein(a) (RR = 1.51; 95% CI, 1.01-2.28). The relative risk ratio of albuminuria was 1.68 times greater for those with high levels of lipoprotein(a) vs. those with very low levels (RR = 1.68; 95% CI, 1.12-2.5), and the relative risk ratio of calcified aortic valve disease was 2.03 times greater for those with high levels vs. those with very low levels (RR = 2.03; 95% CI, 1.02-4.01).
The researchers also found that the median level of lipoprotein(a) was 126 nmol/L among those with HbA1c of more than 8.6%, which they categorized as poor metabolic control, while the median level of lipoprotein(a) was 17 nmol/L among those with HbA1c below 6.9% or what the researchers called good metabolic control (P < .01).
“Lipoprotein(a) is a significant risk factor for cardiovascular disease, albuminuria and calcified aortic valve disease in patients with type 1 diabetes mellitus,” Littmann said. “Measurement of lipoprotein(a) in these patients could possibly improve the cardiovascular risk assessment.” – by Phil Neuffer
For more information:
Karin Littmann, MD, can be reached at karin.littmann@ki.se.
Disclosures: The authors report no relevant financial disclosures.
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Littmann K, et al. Diabetes Care. 2019;doi:10.2337/DC19-1398.
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