A study on lipoprotein(a) in health and type-2 diabetes mellitus
Keywords:Cholesterol, LDLc, Lipoprotein(a), Type 2 diabetes, TGL, VLDLc
Background: Increased lipoprotein (a) [Lp (a)] concentrations are predictive of coronary artery disease (CAD). Type 2 diabetes mellitus also leads to dyslipidemia, which are known risk factors for CAD. This study was designed to investigate the levels of Lp (a) in type 2 diabetic patients and their association with healthy controls and glycemic control.
Methods: The study included 87 subjects out of which 20 were healthy volunteers. The remaining 67 were patients with type 2 diabetes from which 3 groups were formed 23 formed newly diagnosed group while those on treatment for diabetes were 44 out of which 22 were type 2 diabetics on oral hypoglycemic agents and the other 22 were type 2 diabetics on insulin. Individuals suffering from HT, renal disease, liver disease, thyroid dysfunction, nephrotic syndrome & cardiac disease, alcoholics, smokers or on lipid lowering drugs were excluded. Statistical analysis was done using the pearsons correlation.
Results: Lp(a) levels were found to be significantly increased in the diabetic group irrespective of whether newly diagnosed not on treatment or old cases on treatment with oral hypoglycemic agents or insulin. Lp(a) levels showed no correlation to the degree of glycemic control in these patients. Lp(a) positively correlates with total cholesterol, LDLc and negatively with TGL and VLDLc in diabetics while it does not correlate with any of the lipid parameters in controlsConclusions: The results of the present study suggest that Lp(a) levels are increased in type 2 diabetic patients. The elevated Lp(a) levels do not reflect the glycemic status and correlates with increase in total cholesterol and LDLc suggesting similar metabolic pathways and the genetic connection for LDL and Lp(a).
Utermann G, Weber W. Protein Composition of LP (a) lipoprotein from human plasma. FEBS let. 1983;154:357-61.
Berg K. Lp (a) Lipoprotein: an overview. Chem Phys Lipids. 1994:67- 68:9-16.
Ralph L. Nachman MD. Lipoprotein (a): molecular mischance in the microvasculature - IRCULATION. 1997;96:2485-7.
de Rijke YB, Jürgens G, Hessels EM, Hermann A, van Berkel TJ. In vivo fate and scavenger receptor recognition of oxidized lipoprotein[a] isoforms in rats. J Lipid Res. 1992;33(9):1315-25.
Chapman MJ, Huby T, Nigon F, Thillet J. Lipoprotein (a): implication in atherothrombosis. Atherosclerosis. 1994;110 (Suppl):S69-75.
Hiraga T, Kobayashi T, Okubo M, Nakanishi K, Sugimoto T, Ohashi Y, et al. Prospective study of lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients with diabetes. Diabetes Care. 1995;18(2):241-4.
Leus FR, Leerink CB, Prins J, van Rijn HJ. Influence of Apo(a) phenotype on Lp(a) qualification- Evaluation of 3 methods- Clinical Biochemistry. 1994;(27):449-55.
Paul M, Ridker MD. A prospective study of Lp(a) and the risk of Myocardial Infarction. JAMA. 1993;2710(18):n2195-99.
Karmansky I, Gruener N. structure and Possible biological roles of Lp (a). Clinical Biochemistry. 1994;27(3):157-62.
Hiraga T, Shimada M, Okubo M, Nakanishi K, Kobayashi T, Murase T. Lipoprotein (a) is an independent risk factor for multiple cerebral infarctions. Atherosclerosis. 1996;122:29-32.
Enas EA, Dhawan J, Petkar S. Coronary artery disease in Asian Indians: lessons learnt and the role of lipoprotein(a). Indian Heart J. 1997;49(1):25-34.
Wright LC, Sullivan DR. Muller M, Dyne M, Tattersall MHN, Mountford CE. Elevated apolipoprotein (a) levels in cancer patients. Int J Cancer. 1989:43:241-4.
Engler H, Riesen W. Effect of Thyroid function on concentration of lipoprotein(a) . Clin. Chem. 1993;39:246609.
Feely J, Barry M, Keeling PW, Weir DG, Cooke T. Lipoprotein(a) in cirrhosis. BMJ. 1992;304:545-6.
Kung AW, Pang RW, Lauder I, Lam KS, Janus ED. Changes in serum Lipoprotein(a) and Lipids during treatment of hypothyroidism. Clin. Chem. 1995:41:226-31.
Relimpio F. High Lp(a) levels in type 1 and 2 Diabetic patients with microalbuminuria. Diabetes Care. 2000;20(12):1921-2.
Kaysen GA. Plasma Composition in Nephrotic Syndrome. Am J Nephrol. 1993:13:347-54.
Kamanna VS, Roh DD, Kirschenbaum MA. Editorial. Atherogenic lipoproteins-Mediators of Glomerular injury. Am J Nephrology. 1993;13:1-5.
Mohan V. Lp(a) is an independent risk factor for coronary artery disease in NIDDM patients in South India.Diabetes Care. 1990;21(11):1819-23.
Angela M, Scanu MD. Atherothrombogenecity of Lipoprotein (a) : The Debate - Am.J.Cardiology. 1998;82:262-32.
Elliot S, Barnathan MD. Has little Lp(a) shrunk? JAMA. 1993;270(18):2224-5.
Nilausen K, Meinertz H. Lipoproteinm (a) and Dietary Proteins: Casein lowers Lipoprotein(a) concentrations as compared with soy protein. Amer J Clin Nut. 1999;69:3:419-25.
Heller FR, Jamart J, Honore P, Dermeet G. Serum Lipoprotein (a) in patients with Diabetes Mellitus. Diabetes Care. 1998;16(5):819-23.
Howard BV, Abbott WGH, Bettz WF. Integrated study of low density lipoprotein metabolism and very low density lipoprotein metabolism in non-insulin dependent diabetes. Metabolism 1987,36:870-7.
Pérez A, Carreras G, Caixàs A, Castellví A, Caballero A, Bonet Ret al. Plasma lipoprotein(a) levels are not influenced by glycemic control in Type I diabetes. Diabetes Care. 1998;21(9):1517-20.