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

Authors
 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 
Citation
 JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS, Vol.22(5) : 527-534, 2015 
Journal Title
JOURNAL OF ATHEROSCLEROSIS AND THROMBOSIS
ISSN
 1340-3478 
Issue Date
2015
MeSH
Aged ; Coronary Artery Disease/complications* ; Diabetes Mellitus, Type 2/blood* ; Diabetes Mellitus, Type 2/complications ; Female ; Humans ; Lipoprotein(a)/blood* ; Male ; Middle Aged ; Prognosis
Keywords
Lipoprotein(a) ; Diabetes ; Coronary artery disease ; Prognosis ; Adverse cardiac events
Abstract
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.
Files in This Item:
T201506557.pdf Download
DOI
10.5551/jat.25551
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Hospital Medicine (입원의학과) > 1. Journal Papers
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kwon, Hyuck Moon(권혁문) ORCID logo https://orcid.org/0000-0001-9901-5015
Kim, Ki Hyun(김기현)
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Yoon, Young Won(윤영원) ORCID logo https://orcid.org/0000-0002-0907-0350
Lee, Byoung Kwon(이병권) ORCID logo https://orcid.org/0000-0001-9259-2776
Rhee, Ji Hyuk(이지혁)
Rim, Se Joong(임세중) ORCID logo https://orcid.org/0000-0002-7631-5581
Cha, Jung-Joon(차정준) ORCID logo https://orcid.org/0000-0002-8299-1877
Choi, Eui Young(최의영) ORCID logo https://orcid.org/0000-0003-3732-0190
Hong, Bum Kee(홍범기) ORCID logo https://orcid.org/0000-0002-6456-0184
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/155685
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