Investigating the Atherogenic Risk of Lipoprotein(a) in Type 2 Diabetic Patients

Lipoprotein(a) as a Higher Residual Risk for Coronary Artery Disease in Patients with Type 2 Diabetes Mellitus than without

Purpose

Lipoprotein(a) (Lp[a]) is well-known as a residual risk factor for coronary artery disease (CAD). However, the different adverse effects of Lp(a) about CAD in patients with or without type 2 diabetes mellitus (T2DM) are unclear. This study aimed to investigate the Lp(a) thresholds for CAD diagnosis in T2DM and non-T2DM patients, and further compare the Lp(a) alarm values along with optimal low-density lipoprotein cholesterol (LDL-C) level.

Methods

This retrospective study consecutively enrolled patients with suspected CAD who underwent coronary angiography in Guangdong Provincial People's Hospital between September 2014 and July 2015. A logistic regression model was established to explore the association of Lp(a) and CAD in patients. Restricted cubic splines were used to compare the threshold values of Lp(a) for CAD in patients with and without T2DM, and further in optimal LDL-C level situation.

Results

There were 1522 patients enrolled finally. After multivariable adjustment, Lp(a) was an independent risk factor for CAD in patients with T2DM (odds ratio [OR]: 1.98, 95% CI]: 1.12-3.49, p = 0.019) and without T2DM (OR: 3.42, 95% CI: 2.36-4.95, p < 0.001). In the whole population, the Lp(a) threshold of CAD was 155, while 145 mg/L for T2DM and 162 mg/L for non-T2DM ones, respectively. In patients with LDL-C<1.8 mmol/l, the alarm value of Lp(a) was even lower in T2DM than non-T2DM patients (155 vs 174 mg/L).

Conclusion

Lp(a) was a significant residual risk for CAD in patients whether with T2DM or not. And Lp(a) had a lower alarm value in T2DM patients, especially in optimal LDL-C level.

The vascular impact of dapagliflozin, liraglutide, and atorvastatin alone or in combinations in type 2 diabetic rat model

Diabetic dyslipidemia is a significant contributor in the pathogenesis of type 2 diabetes (T2D). The study aimed at comparing the effect of dapagliflozin, liraglutide, and atorvastatin alone or their combinations on lipids and inflammatory markers and their vascular impact in T2D rats. There were 56 male albino rats included in the study and divided into two main groups. Group A (8 rats) served as normal control. Group B (48 rats) were streptozotocin-nicotinamide-induced diabetic rats. Subgroups (B-1, B-2, B-3, B-4, B-5, and B-6) received (no medications, dapagliflozin, liraglutide, atorvastatin, dapagliflozin + atorvastatin, and liraglutide + atorvastatin), respectively. Urine albumin/creatinine ratio (UACR), glycosylated hemoglobin (HBA1c), fasting serum glucose (FSG), serum low-density lipoprotein-cholesterol (LDL-C), high-density lipoprotein-cholesterol (HDL-C), TGs, lipoprotein(a) Lp (a), serum thyrotropin (TSH), highly sensitive C-reactive protein (hs-CRP) and advanced glycation end products (AGEs), were assessed. Qualitative and quantitative histological examination of kidneys focused on renal corpuscles. Dapagliflozin improved the studied parameters but with statistically insignificant increase in LDL-C, Lp (a) and significant increase in UACR. Atorvastatin improved the studied parameters but with statistically insignificant increase in FSG and HbA1C. Liraglutide and the combination groups significantly improved all studied parameters. Histologically, liraglutide and atorvastatin produced therapeutic effect, while dapagliflozin depicted nephrotoxic effect. Combination groups resulted in better effects with normalization of most of renal corpuscles. There were positive correlations between LDL-C and hs-CRP, AGEs, TSH and mesangial expansion. Combination of atorvastatin with liraglutide can improve its vasculoprotective effect. Moreover, combination of atorvastatin with dapagliflozin can ameliorate its possible nephrotoxic effect.

Association of C-peptide and lipoprotein(a) as two predictors with cardiometabolic biomarkers in patients with type 2 diabetes in KERCADR population-based study

We sought association between serum Lipoprotein(a) and C-Peptide levels as two predictors with cardiometabolic biomarkers in patients with type 2 diabetes mellitus. This nested case-control study was conducted on 253 participants with type 2 diabetes mellitus and control from the second phase of the KERCADR cohort study. The participants were randomly allocated into case and control groups. The quantitative levels of Lipoprotein(a) and C-Peptide were measured by ELISA. Atherogenic indices of plasma were measured. The plasma Atherogenic Index of Plasma significantly decreased (P = 0.002) in case-male participants, and plasma Castelli Risk Index II level significantly increased (P = 0.008) in control-male participants with the highest dichotomy of Lipoprotein(a). The plasma Atherogenic Index of Plasma level in case-female participants significantly increased (P = 0.023) with the highest dichotomy of C-Peptide. Serum C-Peptide level significantly increased (P = 0.010 and P = 0.002, respectively) in control-male participants with the highest dichotomies of Atherogenic Index of Plasma and Castelli Risk Index I. There was a significant association between the highest quartile of C-Peptide and higher anthropometric values in case participants; and higher atherogenic indices of plasma and anthropometric values in control participants. Raised serum C-peptide than raised Lipoprotein(a) can be a prior predictor for cardiometabolic disease risk in healthy participants and patients with type 2 diabetes mellitus with increased cardiometabolic biomarkers. Case and control males with general and visceral obesity and case and control females with visceral obesity are exposure to increased C-peptide, respectively. Lipoprotein(a) may be risk independent biomarker for type 2 diabetes mellitus. Reducing raised Lipoprotein(a) levels to less than 30ng/ml with strict control of low density lipoprotein cholesterol would be the best approach to prevent coronary artery disease consequences. It is suggested that a screening system be set up to measure the Lp(a) levels in the community for seemingly healthy people or individuals with one or more cardiometabolic biomarkers.

Assessment of Common Risk Factors and Lifestyle Habits Associated with Atherogenic Risk and Lipid-Lowering Therapy in Men with Type 2 Diabetes

Background and aims: Our objective was to determine common risk factors and lifestyle habits associated with atherogenic risk and with the use of lipid-lowering therapy in men with type 2 diabetes.

Material and Methods: A comparative cross-sectional study was performed in the northwestern Algeria during eleven months on adult men patients with type 2 diabetes. Anthropometric parameters, blood pressures and lipid profile were evaluated. Data of common risk factors and lifestyle habits associated to atherosclerosis were compared between two groups according to the lipid lowering therapy use based on statins.

Results: 147 adult men patients with type 2 diabetes were involved in the study, 68 (46.26%) were under statins therapy and 79 (53.74%) were not. Significant associations with statins use were observed regarding the age group of 61-70 years (OR: 0.156 [0.043-0.570]; p=0.005), a salary of less than 30000 Algerian dinars (≈250.60$) (OR: 5.758 [1.299-25.512]; p=0.021), age of diabetes of 2-3 years (OR: 0.105 [0.013-0.867]; p=0.036) as well as with lipid ratios and body mass index (BMI). However, no significant associations were noted regarding the other studied parameters (marital status, educational level, occupation, salary, and family history, smoking status, alcohol consumption and sports practices) with lipid lowering therapy.

Conclusion: Age of patients, diabetes duration, lipid ratios and the low income of patients are the strongest factors associated with the use of lipid lowering therapy (statins). However, largest longitudinal studies are needed to determine whether modifiable lifestyle habits could influence the lipid lowering therapies prescription in diabetic patients over time.