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

 Sung Woo Kwon  ;  Jong-Youn Kim  ;  Ji Min Sung  ;  Young Won Yoon  ;  Ji-Hyuck Rhee  ;  Byoung Kwon Lee  ;  Young-Hak Jung  ;  Ki-Hyun Kim  ;  Jung-Joon Cha  ;  Jong-Kwan Park  ;  Eui-Young Choi  ;  Bum-Kee Hong  ;  Se-Joong Rim  ;  Hyuck Moon Kwon 
 Journal of Atherosclerosis and Thromobosis, Vol.22(5) : 527-534, 2015 
Journal Title
 Journal of Atherosclerosis and Thromobosis 
Issue Date
AIM: In addition to type 2 diabetes, an elevated Lp(a) level is known to be a surrogate biomarker of cardiovascular disease. However, recent studies have demonstrated that the Lp(a) levels are lower in type 2 diabetic patients than in non-diabetic subjects. 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% men, mean age: 63.5 ± 10.3 years) were enrolled. CAD was diagnosed using invasive coronary angiography, and laboratory values for lipid parameters, including Lp(a), were obtained on the day of coronary angiography. The patients were divided into tertile groups according to the individual Lp(a) level. The baseline characteristics, coronary angiographic findings, duration of follow-up and major adverse cardiovascular events (MACEs) were recorded. RESULTS: Over a mean follow-up period of 4.4 ± 2.6 years, there were 59 MACEs (35 cardiac deaths and 24 cases of non-fatal myocardial infarction), for an event rate of 3.9%. A survival probability plot according to the Lp(a) tertile revealed that an elevated Lp(a) level was associated with a worse prognosis (p = 0.008), after adjusting for age, gender, hypertension, hyperlipidemia, smoking and the extent of CAD. Furthermore, the addition of an elevated Lp(a) level to the reference model improved the 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) values. CONCLUSIONS: In terms of the prognosis, elevated Lp(a) is associated with worse outcomes in type 2 diabetic patients with symptomatic CAD. Furthermore, an elevated Lp(a) level has incremental prognostic value in type 2 diabetic patients with symptomatic CAD.
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1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
권혁문(Kwon, Hyuck Moon) ORCID logo https://orcid.org/0000-0001-9901-5015
김기현(Kim, Ki Hyun)
김종윤(Kim, Jong Youn) ORCID logo https://orcid.org/0000-0001-7040-8771
윤영원(Yoon, Young Won) ORCID logo https://orcid.org/0000-0002-0907-0350
이병권(Lee, Byoung Kwon) ORCID logo https://orcid.org/0000-0001-9259-2776
이지혁(Rhee, Ji Hyuk)
임세중(Rim, Se Joong) ORCID logo https://orcid.org/0000-0002-7631-5581
차정준(Cha, Jung-Joon) ORCID logo https://orcid.org/0000-0002-8299-1877
최의영(Choi, Eui Young) ORCID logo https://orcid.org/0000-0003-3732-0190
홍범기(Hong, Bum Kee) ORCID logo https://orcid.org/0000-0002-6456-0184
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