The association between lipoprotain (a) and carotid atherosclerosis in patients with type 2 diabetes

Object: Lipoprotein(a) [Lp(a)] has been considered as a determinant of residual cardiovascular (CV) risk although target LDL-cholesterol level has been achieved. We aimed at investigating the relation of Lp(a) level to CIMT and carotid plaque in patients with type 2 diabetes. Methods: This cross-sectional study included 662 type 2 diabetic patients (mean age 54.9 years, male 57.9%, mean duration of diabetes 5.6 years) without previous CV disease. The mean of six measurements from the right and left carotid arteries was used, and a carotid plaque was defined as a focal wall thickening >50% of the surrounding IMT or its CIMT ≥1.5 mm. Results: Log-transformed Lp(a) level was significantly higher in group with mean CIMT ≥1.0 mm or having carotid plaque. The odds ratio (OR) of mean CIMT ≥1.0 mm was 4.50 (95% CI 2.53-8.00; p<0.001) and the OR of having carotid plaque was 1.33 (95% CI 1.09-1.62; p=0.006) per 1 SD difference in log-transformed Lp(a) level, after adjusting other cardiometabolic parameters. Lp(a) level was still independent risk factor for elevated CIMT (OR per 1 SD increase 4.29, 95% CI 2.12-8.67; p<0.001) and presence of carotid plaque (OR per 1 SD increase 1.48, 95% CI 1.16-1.88; p=0.001) in subjects with wellcontrolled LDL-cholesterol level less than 100 mg/dL. Conclusion: Elevated Lp (a) level is significantly and independently associated with increased CIMT and presence of carotid artery plaque in patients with type 2 diabetes, even including those with optimal LDL-cholesterol level.