Resident Anne Arundel medical center Annapolis, Maryland, United States
Objective : Elevated levels of Lipoprotein(a) (Lp(a)) are an independent risk factor for cardiovascular disease. Complicating this, low Lp(a) levels are known to be associated with a higher incidence of type 2 diabetes mellitus (T2DM). At the same time, there are studies that suggest moderate reduction of Lp(a) induced by PCSK9 inhibitors does not lead to significant hyperglycemia. Thus, there is an ongoing debate regarding Lp(a) association with T2DM. In this study, the investigation focused on levels of Lp(a) in T2DM in relation to major adverse cardiovascular events (MACE).
Methods: This study utilized a de-identified electronic health record (EHR). The dataset comprised records of 11,134 patients who had undergone Lp(a) measurement. In this sample, patients with T2DM were identified by either a HgbA1c >/= 6.5% or a blood glucose measurement >/= 200 mg/dL, alongside diabetes-specific prescription medications of insulin or metformin. Patients on specific cardiovascular drugs which could be potential confounders were excluded, including aspirin, plavix, statins, antihypertensives, and anticoagulants. With the above criteria applied, 2,268 patients with T2DM were segregated into two distinct cohorts for the purpose of comparing Lp(a) levels in these two sample populations. The two cohorts were as follows: patients with major adverse cardiovascular events (MACE), labelled as “Cardiac Group”; and patients without MACE, the “Non-Cardiac Group”. The Non-Cardiac Group served as a comparative baseline to evaluate the association between Lp(a) levels and MACE in diabetic individuals. The last recorded Lp(a) value for each patient was extracted from the dataset and was compared between the two groups. Welch T-test was applied to assess if the difference between mean Lp(a) levels between both the groups was statistically significant (α = 0.05). The analysis was performed using Python.
Results: There was a significant difference (p value of 0.0004) between the mean Lp(a) levels for patients with MACE (mean=30.8 mg/dl) compared to without MACE (mean=24.3 mg/dl); thus a higher mean Lp(a) level in T2DM patients with MACE.
Discussion/Conclusion: The fact that Lp(a) levels vary significantly between type 2 diabetics experiencing MACE and those without MACE would imply that despite the controversial association of Lp(a) with T2DM, Lp(a) does indeed contribute to morbidity even in T2DM. Thus, this lipoprotein, which does not respond to most lipid-lowering therapies and is an established marker for MACE, requires further investigation regarding treatment options, even in patients with T2DM.
