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Increased plasma apolipoprotein(a) levels in IDDM patients with microalbuminuria
A J Jenkins1, J S Steele, E D Janus
1Department of Chemical Pathology, St. Vincent's Hospital, Melbourne, Australia.
Abstract:
Patients with insulin-dependent diabetes mellitus (IDDM) have a significantly increased risk of macrovascular disease, particularly if they have persistent proteinuria. To determine whether altered levels of apolipoprotein(a) [apo(a)], the plasminogenlike glycoprotein of the potentially atherogenic lipoprotein(a); contribute to the increased risk of atherosclerosis, apo(a) levels were measured in 107 patients with IDDM and compared with nondiabetic control subjects and male elective coronary artery graft patients. Apo(a) levels were increased in diabetic patients with microalbuminuria (geometric mean 245 U/L, 95% confidence interval [CI] 142-427, n = 30) and albuminuria (mean 196 U/L, 95% CI 97-397, n = 18) with levels comparable to patients with coronary artery disease (mean 193 U/L, 95% CI 126-298, n = 40), which were higher than in the control group (mean 107 U/L, 95% CI 85-134, n = 140; P = 0.016). Apo(a) levels in diabetic patients without microalbuminuria (mean 86 U/L, 95% CI 63-116, n = 59) were comparable with the control population and less than in those with microalbuminuria (P less than 0.001) and albuminuria (P = 0.014). The elevated apo(a) levels found in patients with IDDM and increased urinary albumin loss may contribute to their heightened risk of macrovascular disease.
Insights
Patients with insulin-dependent diabetes mellitus (IDDM) have higher levels of apolipoprotein(a) (apo(a)) if they also have proteinuria. These elevated apo(a) levels may increase their risk of macrovascular disease.
Area of Science:
- Cardiology
- Endocrinology
- Metabolic Syndrome
Background:
- Insulin-dependent diabetes mellitus (IDDM) significantly elevates macrovascular disease risk, especially with persistent proteinuria.
- Lipoprotein(a) [Lp(a)], containing apolipoprotein(a) [apo(a)], is implicated in atherosclerosis.
- The role of apo(a) levels in IDDM patients' heightened atherosclerosis risk requires clarification.
Purpose of the Study:
- To investigate the association between altered apolipoprotein(a) levels and macrovascular disease risk in patients with IDDM.
- To compare apo(a) levels in IDDM patients with varying degrees of proteinuria against control groups.
Main Methods:
- Apolipoprotein(a) [apo(a)] levels were quantified in 107 patients with IDDM.
- IDDM patients were stratified based on the presence and severity of microalbuminuria and albuminuria.
- Apo(a) levels were compared between IDDM subgroups, nondiabetic controls, and patients with coronary artery disease.
Main Results:
- IDDM patients with microalbuminuria and albuminuria exhibited significantly elevated apo(a) levels compared to controls.
- Apo(a) levels in diabetic patients with proteinuria were comparable to those with established coronary artery disease.
- Diabetic patients without microalbuminuria had apo(a) levels similar to the control population.
Conclusions:
- Elevated apolipoprotein(a) levels are present in IDDM patients with increased urinary albumin loss.
- These heightened apo(a) levels may be a contributing factor to the increased macrovascular disease risk observed in these patients.