Lipoprotein (a) kao pretkazatelj progresije debljine intime-medije karotidnih arterija u osoba s tipom 2 šećerne bolesti

The aim of this study was to establish whether increased serum Lp(a) level is a risk factor which significantly contributes to an increase in intima-media thickness (IMT) and the number of carotid artery plaques, and the related increased risk of cardiovascular morbidity and mortality in patients with type 2 diabetes mellitus. The study included 146 type 2 diabetic patients without signs of cerebrovascular and ischaemic heart disease. The levels of Lp(a) and IMT, as well as the number of carotid artery plaques were determined at the beginning of the study. IMT and the number of carotid artery plaques were again determined after four years of follow-up. Subjects were divided into two groups according to their serum Lp(a) levels: patients with Lp(a) level of ≤30 mg/dL and those with Lp level >30 mg/dL. IMT was assessed by high-resolution B-mode ultrasound. Serum Lp(a) level was determined using immunoturbidimetric method. The studied groups of patients with high and low serum Lp(a) levels did not reveal significant differences in baseline IMT (p=0.112). After a 4-yr follow-up IMT was significantly greater in patients with Lp(a) level >30 mg/dL as compared to those with Lp(a) level of ≤30 mg/dL (1.24 + 0.22 mm vs. 1.15+0.17 mm, respectively ; p=0.05). Mean increase in IMT over four years in the group with low Lp(a) level was 0.12 mm (0.030 mm/yr.), whereas in the group with high Lp(a) level it was 0.17 mm (0.043 mm/yr.). Multivariate analysis indicated that IMT value depended on Lp(a), and not on triglyceride and HDL-cholesterol levels. The studied patients from both groups did not show significant difference in baseline number of plaques (p=0.276). A significant increase in the number of plaques (p0.05). These results point to Lp(a) as an independent, genetically determined risk factor associated with IMT progression in type 2 diabetes mellitus