Advertisement

Impact of Lipoprotein(a) on Long-term Outcomes in Patients With Diabetes Mellitus Who Underwent Percutaneous Coronary Intervention

Published:September 13, 2016DOI:https://doi.org/10.1016/j.amjcard.2016.08.067
      Patients with diabetes mellitus (DM) are at twofold to fourfold higher cardiovascular risk than those without DM. Serum levels of lipoprotein(a) (Lp(a)) can be risk factors for adverse events. However, the clinical implications of Lp(a) in patients with DM who underwent percutaneous coronary intervention (PCI) is unknown. The aim of the study was to determine the role of Lp(a) in patients with DM who underwent PCI. A total of 3,508 patients were treated by PCI from 1997 to 2011 at our institution. Among them, we analyzed consecutive 1,546 patients with DM. Eligible 1,136 patients were divided into 2 groups (high Lp(a) [n = 575] and low Lp(a) [n = 561]) by the median of Lp(a) levels. The number of chronic kidney disease, multivessel disease, and the level of LDL-C were higher in the group with high Lp(a) than with low Lp(a). The median follow-up period was 4.7 years. Event rate of all-cause death was same between the 2 groups (p = 0.37). However, cumulative incidence of cardiac death and acute coronary syndrome was significantly higher in the high Lp(a) than in the low Lp(a) group (p = 0.03). Multivariable analysis selected a high Lp(a) level as an independent predictor of cardiac death and acute coronary syndrome (hazard ratio 1.20; 95% confidence interval 1.00 to 1.42; p = 0.04). In conclusion, a high Lp(a) value could be associated with advanced cardiac events after PCI for patients with DM.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'

      Subscribe:

      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect

      References

        • Beckman J.A.
        • Creager M.A.
        • Libby P.
        Diabetes and atherosclerosis: epidemiology, pathophysiology, and management.
        JAMA. 2002; 287: 2570-2581
        • Roffi M.
        • Angiolillo D.J.
        • Kappetein A.P.
        Current concepts on coronary revascularization in diabetic patients.
        Eur Heart J. 2011; 32: 2748-2757
        • Steyrer E.
        • Durovic S.
        • Frank S.
        • Giessauf W.
        • Burger A.
        • Dieplinger H.
        • Zechner R.
        • Kostner G.M.
        The role of lecithin: cholesterol acyltransferase for lipoprotein (a) assembly. Structural integrity of low density lipoproteins is a prerequisite for Lp(a) formation in human plasma.
        J Clin Invest. 1994; 94: 2330-2340
        • Ikenaga H.
        • Ishihara M.
        • Inoue I.
        • Kawagoe T.
        • Shimatani Y.
        • Miura F.
        • Nakama Y.
        • Dai K.
        • Otani T.
        • Ejiri K.
        • Oda N.
        • Nakamura M.
        • Miki T.
        Usefulness of lipoprotein (a) for predicting progression of non-culprit coronary lesions after acute myocardial infarction.
        Circ J. 2011; 75: 2847-2852
        • Kardys I.
        • Oemrawsingh R.M.
        • Kay I.P.
        • Jones G.T.
        • McCormick S.P.
        • Daemen J.
        • Van Geuns R.J.
        • Boersma E.
        • Van Domburg R.T.
        • Serruys P.W.
        Lipoprotein(a), interleukin-10, C-reactive protein, and 8-year outcome after percutaneous coronary intervention.
        Clin Cardiol. 2012; 35: 482-489
        • Kronenberg F.
        • Utermann G.
        • Dieplinger H.
        Lipoprotein(a) in renal disease.
        Am J Kidney Dis. 1996; 27: 1-25
        • Thygesen K.
        • Alpert J.S.
        • White H.D.
        • Jaffe A.S.
        • Apple F.S.
        • Galvani M.
        • Katus H.A.
        • Newby L.K.
        • Ravkilde J.
        • Chaitman B.
        • Clemmensen P.M.
        • Dellborg M.
        • Hod H.
        • Porela P.
        • Underwood R.
        • Bax J.J.
        • Beller G.A.
        • Bonow R.
        • Van der Wall E.E.
        • Bassand J.P.
        • Wijns W.
        • Ferguson T.B.
        • Steg P.G.
        • Uretsky B.F.
        • Williams D.O.
        • Armstrong P.W.
        • Antman E.M.
        • Fox K.A.
        • Hamm C.W.
        • Ohman E.M.
        • Simoons M.L.
        • Poole-Wilson P.A.
        • Gurfinkel E.P.
        • Lopez-Sendon J.L.
        • Pais P.
        • Mendis S.
        • Zhu J.R.
        • Wallentin L.C.
        • Fernández-Avilés F.
        • Fox K.M.
        • Parkhomenko A.N.
        • Priori S.G.
        • Tendera M.
        • Voipio-Pulkki L.M.
        • Vahanian A.
        • Camm A.J.
        • De Caterina R.
        • Dean V.
        • Dickstein K.
        • Filippatos G.
        • Funck-Brentano C.
        • Hellemans I.
        • Kristensen S.D.
        • McGregor K.
        • Sechtem U.
        • Silber S.
        • Tendera M.
        • Widimsky P.
        • Zamorano J.L.
        • Morais J.
        • Brener S.
        • Harrington R.
        • Morrow D.
        • Lim M.
        • Martinez-Rios M.A.
        • Steinhubl S.
        • Levine G.N.
        • Gibler W.B.
        • Goff D.
        • Tubaro M.
        • Dudek D.
        • Al-Attar N.
        • Joint ESC/ACCF/AHA/WHF Task Force for the Redefinition of Myocardial Infarction
        Universal definition of myocardial infarction.
        Circulation. 2007; 116: 2634-2653
        • Jaffe A.S.
        • Ravkilde J.
        • Roberts R.
        • Naslund U.
        • Apple F.S.
        • Galvani M.
        • Katus H.
        It's time for a change to a troponin standard.
        Circulation. 2000; 102: 1216-1220
        • Cannon C.P.
        • Brindis R.G.
        • Chaitman B.R.
        • Cohen D.J.
        • Cross Jr., J.T.
        • Drozda Jr., J.P.
        • Fesmire F.M.
        • Fintel D.J.
        • Fonarow G.C.
        • Fox K.A.
        • Gray D.T.
        • Harrington R.A.
        • Hicks K.A.
        • Hollander J.E.
        • Krumholz H.
        • Labarthe D.R.
        • Long J.B.
        • Mascette A.M.
        • Meyer C.
        • Peterson E.D.
        • Radford M.J.
        • Roe M.T.
        • Richmann J.B.
        • Selker H.P.
        • Shahian D.M.
        • Shaw R.E.
        • Sprenger S.
        • Swor R.
        • Underberg J.A.
        • Van de Werf F.
        • Weiner B.H.
        • Weintraub W.S.
        2013 ACCF/AHA key data elements and definitions for measuring the clinical management and outcomes of patients with acute coronary syndromes and coronary artery disease: a report of the American College of Cardiology Foundation/American Heart Association Task Force on clinical data standards (Writing Committee to Develop Acute Coronary Syndromes and Coronary Artery Disease Clinical Data Standards).
        Circulation. 2013; 127: 1052-1089
        • Kostner K.M.
        • März W.
        • Kostner G.M.
        When should we measure lipoprotein (a)?.
        Eur Heart J. 2013; 34: 3268-3276
        • Erqou S.
        • Kaptoge S.
        • Perry P.L.
        • Di Angelantonio E.
        • Thompson A.
        • White I.R.
        • Marcovina S.M.
        • Collins R.
        • Thompson S.G.
        • Danesh J.
        • Emerging Risk Factors Collaboration
        Lipoprotein(a) concentration and the risk of coronary heart disease, stroke, and nonvascular mortality.
        JAMA. 2009; 302: 412-423
        • Di Angelantonio E.
        • Gao P.
        • Pennells L.
        • Kaptoge S.
        • Caslake M.
        • Thompson A.
        • Butterworth A.S.
        • Sarwar N.
        • Wormser D.
        • Saleheen D.
        • Ballantyne C.M.
        • Psaty B.M.
        • Sundström J.
        • Ridker P.M.
        • Nagel D.
        • Gillum R.F.
        • Ford I.
        • Ducimetiere P.
        • Kiechl S.
        • Koenig W.
        • Dullaart R.P.
        • Assmann G.
        • D'Agostino Sr., R.B.
        • Dagenais G.R.
        • Cooper J.A.
        • Kromhout D.
        • Onat A.
        • Tipping R.W.
        • Gómez-de-la-Cámara A.
        • Rosengren A.
        • Sutherland S.E.
        • Gallacher J.
        • Fowkes F.G.
        • Casiglia E.
        • Hofman A.
        • Salomaa V.
        • Barrett-Connor E.
        • Clarke R.
        • Brunner E.
        • Jukema J.W.
        • Simons L.A.
        • Sandhu M.
        • Wareham N.J.
        • Khaw K.T.
        • Kauhanen J.
        • Salonen J.T.
        • Howard W.J.
        • Nordestgaard B.G.
        • Wood A.M.
        • Thompson S.G.
        • Boekholdt S.M.
        • Sattar N.
        • Packard C.
        • Gudnason V.
        • Danesh J.
        • Emerging Risk Factors Collaboration
        Lipid-related markers and cardiovascular disease prediction.
        JAMA. 2012; 307: 2499-2506
        • Dangas G.
        • Ambrose J.A.
        • D'Agate D.J.
        • Shao J.H.
        • Chockalingham S.
        • Levine D.
        • Smith D.A.
        Correlation of serum lipoprotein(a) with the angiographic and clinical presentation of coronary artery disease.
        Am J Cardiol. 1999; 83: 583-585
        • Schwartzman R.A.
        • Cox I.D.
        • Poloniecki J.
        • Crook R.
        • Seymour C.A.
        • Kaski J.C.
        Elevated plasma lipoprotein(a) is associated with coronary artery disease in patients with chronic stable angina pectoris.
        J Am Coll Cardiol. 1998; 31: 1260-1266
        • Kwon S.W.
        • Lee B.K.
        • Hong B.K.
        • Kim J.Y.
        • Choi E.Y.
        • Sung J.M.
        • Rhee J.H.
        • Park Y.M.
        • Ma D.W.
        • Chung H.
        • Mun H.S.
        • Lee S.J.
        • Park J.K.
        • Min P.K.
        • Yoon Y.W.
        • Rim S.J.
        • Kwon H.M.
        Prognostic significance of elevated lipoprotein(a) in coronary artery revascularization patients.
        Int J Cardiol. 2013; 167: 1990-1994
        • Shai I.
        • Schulze M.B.
        • Manson J.E.
        • Stampfer M.J.
        • Rifai N.
        • Hu F.B.
        A prospective study of lipoprotein(a) and risk of coronary heart disease among women with type 2 diabetes.
        Diabetologia. 2005; 48: 1469-1476
        • Hiraga T.
        • Kobayashi T.
        • Okubo M.
        • Nakanishi K.
        • Sugimoto T.
        • Ohashi Y.
        • Murase T.
        Prospective study of lipoprotein(a) as a risk factor for atherosclerotic cardiovascular disease in patients with diabetes.
        Diabetes Care. 1995; 18: 241-244
        • Hernández C.
        • Francisco G.
        • Chacón P.
        • Simó R.
        Lipoprotein(a) as a risk factor for cardiovascular mortality in type 2 diabetic patients: a 10-year follow-up study.
        Diabetes Care. 2005; 28: 931-933
        • Haffner S.M.
        • Moss S.E.
        • Klein B.E.
        • Klein R.
        Lack of association between lipoprotein (a) concentrations and coronary heart disease mortality in diabetes: the Wisconsin Epidemiologic Study of Diabetic Retinopathy.
        Metabolism. 1992; 41: 194-197
        • Abu-Lebdeh H.S.
        • Hodge D.O.
        • Nguyen T.T.
        Predictors of macrovascular disease in patients with type 2 diabetes mellitus.
        Mayo Clin Proc. 2001; 76: 707-712
        • Maher V.M.
        • Brown B.G.
        Lipoprotein (a) and coronary heart disease.
        Curr Opin Lipidol. 1995; 6: 229-235
        • Grainger D.J.
        • Kirschenlohr H.L.
        • Metcalfe J.C.
        • Weissberg P.L.
        • Wade D.P.
        • Lawn R.M.
        Proliferation of human smooth muscle cells promoted by lipoprotein(a).
        Science. 1993; 260: 1655-1658
        • Loscalzo J.
        • Weinfeld M.
        • Fless G.M.
        • Scanu A.M.
        Lipoprotein(a), fibrin binding, and plasminogen activation.
        Arteriosclerosis. 1990; 10: 240-245
        • Biondi-Zoccai G.G.
        • Abbate A.
        • Liuzzo G.
        • Biasucci L.M.
        Atherothrombosis, inflammation, and diabetes.
        J Am Coll Cardiol. 2003; 41: 1071-1077
        • Onat A.1
        • Dönmez I.
        • Karadeniz Y.
        • Cakır H.
        • Kaya A.
        Type-2 diabetes and coronary heart disease: common physiopathology, viewed from autoimmunity.
        Expert Rev Cardiovasc Ther. 2014; 12: 667-679
        • Boerwinkle E.
        • Leffert C.C.
        • Lin J.
        • Lackner C.
        • Chiesa G.
        • Hobbs H.H.
        Apolipoprotein(a) gene accounts for greater than 90% of the variation in plasma lipoprotein(a) concentrations.
        J Clin Invest. 1992; 90: 52-60
        • Cannon C.P.
        • Shah S.
        • Dansky H.M.
        • Davidson M.
        • Brinton E.A.
        • Gotto A.M.
        • Stepanavage M.
        • Liu S.X.
        • Gibbons P.
        • Ashraf T.B.
        • Zafarino J.
        • Mitchel Y.
        • Barter P.
        Safety of anacetrapib in patients with or at high risk for coronary heart disease.
        N Engl J Med. 2010; 363: 2406-2415
        • McKenney J.M.
        • Koren M.J.
        • Kereiakes D.J.
        • Hanotin C.
        • Ferrand A.C.
        • Stein E.A.
        Safety and efficacy of a monoclonal antibody to proprotein convertase subtilisin/kexin type 9 serine protease, SAR236553/REGN727, in patients with primary hypercholesterolemia receiving ongoing stable atorvastatin therapy.
        J Am Coll Cardiol. 2012; 59: 2344-2353