High lipoprotein(a) concentrations are associated with lower type 2 diabetes risk in the Chinese Han population: a large retrospective cohort study

Qingan Fu,Lijuan Hu,Yingping Yi,Yuan Xu,Long Jiang

doi:10.1186/s12944-021-01504-x

Abstract

BackgroundLipoprotein (a) [Lp(a)] is a proven independent risk factor for coronary heart disease. It is also associated with type 2 diabetes mellitus (T2DM). However, the correlation between Lp(a) and T2DM has not been clearly elucidated.MethodsThis was a retrospective cohort study involving 9248 T2DM patients and 18,496 control individuals (1:2 matched). Patients were randomly selected from among inpatients in the Second Affiliated Hospital of Nanchang University between 2006 and 2017. Clinical characteristics were compared between the two groups. Spearman rank-order correlation coefficients were used to evaluate the strength and direction of monotonic associations of serum Lp(a) with other metabolic risk factors. Binary logistic regression analysis was used to establish the correlation between Lp(a) levels and T2DM risk.ResultsThe median Lp(a) concentration was lower in T2DM patients than in controls (16.42 vs. 16.88 mg/dL). Based on four quartiles of Lp(a) levels, there was a decrease in T2DM risk from 33.7% (Q1) to 31.96% (Q4) (P for trend < 0.0001). Then, Lp(a) levels > 28.72 mg/dL (Q4) were associated with a significantly lower T2DM risk in the unadjusted model [0.924 (0.861, 0.992), P = 0.030]. Similar results were obtained in adjusted models 1 [Q4, 0.925 (0.862, 0.993), P = 0.031] and 2 [Q4, 0.919 (0.854, 0.990), P = 0.026]. Furthermore, in the stratified analysis, Q4 of Lp(a) was associated with a significantly lower T2DM risk among men [0.813 (0.734, 0.900), P < 0.001] and those age > 60 years [0.819 (0.737, 0.910), P < 0.001]. In contrast, the low-density lipoprotein cholesterol (LDL-C) levels and coronary heart disease (CHD) did not impact these correlations between Lp(a) and diabetes.ConclusionsThere is an inverse association between Lp(a) levels and T2DM risk in the Chinese population. Male patients, especially those aged more than 60 years with Lp(a) > 28.72 mg/dL, are low-risk T2DM individuals, regardless of LDL-C levels and CHD status.

Highlights

Lipoprotein (a) [Lp(a)], discovered in 1963, is plasmabased but has a special structure
Elevated Lp(a) levels exert strong proatherogenic and prothrombotic effects contributing to lifelong elevated risks of cardiovascular disease (CVD), stroke, and valvular aortic stenosis [3]
Clinical characteristics In total, 9248 type 2 diabetes mellitus (T2DM) patients and 18,496 controls matched on age, sex, current smoking status, current alcohol consumption, body mass index (BMI), hypertension, coronary heart disease (CHD), and estimated glomerular filtration rate (eGFR) > 60 mL/(min·1.73 m2) were randomly selected

Summary

Introduction

Lipoprotein (a) [Lp(a)], discovered in 1963, is plasmabased but has a special structure. The 2018 National Heart, Lung, and Blood Institute (NHLBI) Working Group suggested that Lp(a) > 30 mg/ dl (75 nmol/l) or 50 mg/dl (100–125 nmol/l) be considered as “elevated Lp(a)” or “hyperlipoproteinemia(a)”. This implies that, globally, more than 1 billion people have elevated Lp(a) levels and are at a high risk of CVD and aortic stenosis. Lipoprotein (a) [Lp(a)] is a proven independent risk factor for coronary heart disease. It is associated with type 2 diabetes mellitus (T2DM). The correlation between Lp(a) and T2DM has not been clearly elucidated

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