engleski

Lipoprotein(a) seems to be a marker associated with the metabolic syndrome in type 2 diabetes mellitus and with the progression of intima-media thickness

The aim of this study was to establish whether increased serum Lp(a) level was a risk factor significantly contributing to an increase in intima-media thickness (IMT) and the number of carotid artery plaques in patients with type 2 diabetes mellitus. The study included 146 type 2 diabetic patients without signs of cerebrovascular or ischaemic heart disease. The levels of Lp(a) were determined at the beginning of the study. IMT and the number of carotid artery plaques were determined at the beginning and after four years of follow-up. Subjects were divided into two groups according to serum Lp(a) levels (Lp(a)&#8804; 30 mg/dL and Lp(a)>30 mg/dL). IMT was assessed by high-resolution B-mode ultrasound and serum Lp(a) level was determined using immunoturbidimetric method. The groups of patients with high and low serum Lp(a) levels did not reveal significant differences in baseline IMT (p=0.112). After a 4-yr follow-up IMT was significantly greater in patients with Lp(a) level >30 mg/dL as compared to those with Lp(a) &#8804; 30 mg/dL (1.24&plusmn ; ; 0.22 mm vs. 1.15&plusmn ; ; 0.17 mm, respectively ; p=0.05). Mean increase in IMT in the group with low Lp(a) level over four years was 0.12 mm (0.030 mm/yr.), whereas in the group with high Lp(a) level it was 0.17 mm (0.043 mm/yr.). Multivariate analysis indicated that IMT value depended on Lp(a), and not on triglyceride and HDL-cholesterol levels. The studied patients from both groups did not show a significant difference in baseline plaque number (p=0.276). A significant increase in the number of plaques (p<0.001) was found after the 4-yr follow-up as compared to baseline values. There were no significant differences in the number of plaques between the two groups at the end of the study (p=0.355). Lp(a) correlated significantly with HDL-cholesterol (R=-0.221, p=0.014), triglycerides (R=0.324, p<0.001), IMT (R=0.195, p=0.031), plaque number (R=0.205, p=0.023) and waste/hip ratio (WHR) (R=0.208, p=0.021). A statistically significant difference in WHR (p=0.040) and triglycerides (p<0.001) was determined between the studied groups. These results point to Lp(a) as an independent, genetically determined risk factor associated with IMT progression in type 2 diabetes, and as a possible additional parameter of the metabolic syndrome as well.

Lipoprotein(a); metabolic syndrome; intima-media thickness

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