Lipoprotein (a) and Diabetes 

• Elevated lipoprotein(a) (Lp(a)) level is a major determinant of the presence and severity of CAD (coronary artery disease) and cerebrovascular disease (CVD), and PAD (peripheral arterial disease) among patients with diabetes regardless of ethnicity.^1-13

• Elevated Lp(a) level is a strong independent predictor of subclinical atherosclerosis (silent heart disease) as measured by coronary artery calcification score (Heart Scan) or carotid intimal medial thickness.^{1, 3, 14, 15}

• Lp(a) is an independent determinant of aortic stiffness in elderly patients with diabetes.¹⁶

• Lp(a) was associated inversely with risk of type 2 diabetes independently of risk factors, in contrast to prior findings of positive associations of Lp(a) with cardiovascular risk.¹⁷

• Lp(a) levels correlate inversely with insulin levels in Type 2 diabetic patients.¹⁸ Insulin-requiring type II diabetic patients have high levels of Lp(a).¹⁹ Lp(a) may be one of the cardiovascular risk factors in type 2 diabetic patients with longer duration of diabetes.^{18, 20} Conversely, diabetic patients with a high Lp(a) often end up requiring insulin earlier than those without elevated Lp(a).

• Lipoprotein(a) levels are inversely correlated with triglyceride levels in people with and without diabetes.⁷

• Elevated Lp(a) level is associated with various complications including microalbuminuria, nephropathy retinopathy, amputations, heart attack, stroke, and death among patients with diabetes.^21-24

• Diabetes and Lp(a) increase severity of atherosclerosis and CAD and those with both conditions have extremely severe  atherosclerosis. A high prevalence of this combination is a major contributor to the malignant heart disease among young Asian Indians.²⁵

Sources 

1. Qasim AN, Martin SS, Mehta NN, et al. Lipoprotein(a) is strongly associated with coronary artery calcification in type-2 diabetic women. Int J Cardiol. Mar 18 2010.

2. Mohan V, Deepa R, Haranath SP, et al. Lipoprotein(a) is an independent risk factor for coronary artery disease in NIDDM patients in South India. Diabetes Care. Nov 1998;21(11):1819-1823.

3. Velmurugan K, Deepa R, Ravikumar R, et al. Relationship of lipoprotein(a) with intimal medial thickness of the carotid artery in Type 2 diabetic patients in south India. Diabet Med. Jun 2003;20(6):455-461.

4. Gazzaruso C, Garzaniti A, Falcone C, Geroldi D, Finardi G, Fratino P. Association of lipoprotein(a) levels and apolipoprotein(a) phenotypes with coronary artery disease in Type 2 diabetic patients and in non- diabetic subjects. Diabet Med. 2001;18(7):589-594.

5. Ruiz J, Thillet J, Huby T, et al. Association of elevated lipoprotein(a) levels and coronary heart disease in NIDDM patients. Relationship with apolipoprotein(a) phenotypes. Diabetologia. 1994;37(6):585-591.

6. Rasouli M, Mohseni Kiasari A. Interactions of lipoprotein(a) with diabetes mellitus, apolipoprotein B and cholesterol enhance the prognostic values for coronary artery disease. Clin Chem Lab Med. 2008;46(5):667-673.

7. Albahrani A, Alkindi M, Marks E, Alyahyaee S, Shenkin A. Lipoprotein(a): an independent risk factor for ischemic heart disease that is dependent on triglycerides in subjects with type 2 diabetes mellitus. Lipids Health Dis. 2007;6:26.

8. Ben Hamda K, Masmoudi AS, Mandhouj O, et al. [Lipoprotein (a) and ischemic heart diseases in patients with type 2 diabetes]. Arch Inst Pasteur Tunis. 2002;79(1-4):27-33.

9. Koschinsky ML, Marcovina SM. The relationship between lipoprotein(a) and the complications of diabetes mellitus. Acta Diabetol. Jun 2003;40(2):65-76.

10. Murase T, Okubo M, Amemiya-Kudo M, Ebara T, Mori Y. Impact of elevated serum lipoprotein (a) concentrations on the risk of coronary heart disease in patients with type 2 diabetes mellitus. Metabolism. Jun 2008;57(6):791-795.

11. Gazzaruso C, Bruno R, Pujia A, et al. Lipoprotein(a), apolipoprotein(a) polymorphism and coronary atherosclerosis severity in type 2 diabetic patients. Int J Cardiol. Jun 13 2005.

12. Gazzaruso C, Bruno R, Pujia A, et al. Lipoprotein(a), apolipoprotein(a) polymorphism and coronary atherosclerosis severity in type 2 diabetic patients. Int J Cardiol. Apr 14 2006;108(3):354-358.

13. Miyao M, Araki A, Hattori A, et al. [Lipoprotein(a) as a risk factor for cardiovascular disease in elderly patients with diabetes]. Nippon Ronen Igakkai Zasshi. 1997;34(3):185-191.

14. GazzarusoC, Garzaniti A, Giordanetti S, Falcone C, Fratino P. Silent coronary artery disease in type 2 diabetes mellitus: the role of Lipoprotein(a), homocysteine and apo(a) polymorphism. Cardiovasc Diabetol. Nov 22 2002;1:5.

15. Gazzaruso C, Garzaniti A, Giordanetti S, et al. Assessment of asymptomatic coronary artery disease in apparently uncomplicated type 2 diabetic patients: a role for lipoprotein(a) and apolipoprotein(a) polymorphism. Diabetes Care. 2002;25(8):1418-1424.

16. Wakabayashi I, Masuda H. Lipoprotein (a) as a determinant of arterial stiffness in elderly patients with type 2 diabetes mellitus. Clin Chim Acta. May 17 2006.

17. Mora S., Kamstrup PR, Rifai N, Nordestgaard BG, Buring JE, Ridker PM. Lipoprotein(a) and risk of type 2 diabetes. Clin Chem. Aug 2010;56(8):1252-1260.

18. Habib SS, Aslam M, Shah SF, Naveed AK. Lipoprotein (a) is associated with basal insulin levels in patients with type 2 Diabetes Mellitus. Arq Bras Cardiol. Jul 2009;93(1):28-33.

19. Heller FR, Jamart J, Honore P, et al. Serum lipoprotein(a) in patients with diabetes mellitus. Diabetes Care. May 1993;16(5):819-823.

20. Morishita E, Asakura H, Jokaji H, et al. Hypercoagulability and high lipoprotein(a) levels in patients with type II diabetes mellitus. Atherosclerosis. Feb 1996;120(1-2):7-14.

21. Heesen  BJ, Wolffenbuttel BH, Leurs PB, et al. Lipoprotein(a) levels in relation to diabetic complications in patients with non-insulin-dependent diabetes. Eur J Clin Invest. 1993;23(9):580-584.

22. Maca T, Mlekusch W, Doweik L, et al. Influence and interaction of diabetes and lipoprotein (a) serum levels on mortality of patients with peripheral artery disease. Eur J Clin Invest. Mar 2007;37(3):180-186.

23. Tarkun I, Cetinarslan B, Canturk Z. Lipoprotein(a) concentrations in patients with type 2 diabetes mellitus without cardiovascular disease: relationship to metabolic parameters and diabetic complications. Nutr Metab Cardiovasc Dis. Jun 2002;12(3):127-131.

24. Song KH, Ko SH, Kim HW, et al. Prospective study of lipoprotein(a) as a risk factor for deteriorating renal function in type 2 diabetic patients with overt proteinuria. Diabetes Care. Jul 2005;28(7):1718-1723.

25. Enas EA, Mehta J. Malignant coronary artery disease in young Asian Indians: thoughts on pathogenesis, prevention, and therapy. Coronary Artery Disease in Asian Indians (CADI) Study. Clin Cardiol. Mar 1995;18(3):131-135.