Elevated Lipoprotein(a) has Incremental Prognostic Value in Type 2 Diabetic Patients with Symptomatic Coronary Artery Disease

초록

Aim: Along with type 2 diabetes, elevated Lp(a) is also known as a surrogate biomarker for cardiovascular disease. However, recent studies have demonstrated that Lp(a) level was lower in type 2 diabetic patients than in non-diabetic patients. Therefore, we sought to evaluate the prognostic value of elevated lipoprotein(a) [Lp(a)]in type 2 diabetic patients with symptomatic coronary artery disease (CAD). Methods: A total of 1494 diabetic patients with CAD(62.3% male, mean age 63.5 ± 10.3 years) were enrolled. CAD was diagnosed by invasive coronary angiography, and laboratory values for lipid parameters, including Lp(a), were obtained on the day of coronary angiography. Patients were divided into tertile groups according to individualLp(a) levels. Baseline characteristics, coronary angiographic findings, follow-up duration, and major adverse cardiovascular event(MACE) were recorded. Results: Over a mean follow-up period of 4.4±2.6 years, there were 59 MACEs (35 cardiac death and 24 non-fatal myocardial infarction),for an event rate of 3.9%. Survival probability plot according to Lp(a) tertiles revealed that elevated Lp(a) was associated with worse prognosis (p=0.008),after adjusting for age, gender, hypertension, hyperlipidemia, smoking, and extent of CAD.Furthermore, addition of elevated Lp(a) to reference model improved integrated discrimination improvement (0.0216, p<0.001), continuous net reclassification improvement (NRI) (0.5721, p=0.012), and NRI (0.1549, p=0.004). Conclusions: In terms of prognosis, elevated Lp(a) is associated with worse outcome in type 2 diabetic patients with symptomatic CAD. Furthermore, elevated Lp(a) has incremental prognostic value in type 2 diabetic patients with symptomatic CAD.