Original Article

Endocrine

, Volume 41, Issue 1, pp 89-95

First online:

Lipoprotein(a) and homocysteine as genetic risk factors for vascular and neuropathic diabetic foot in type 2 diabetes mellitus

  • Carmine GazzarusoAffiliated withInternal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and The Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo”Department of Internal Medicine, I.R.C.C.S. Policlinico San Donato Email author 
  • , Adriana CoppolaAffiliated withInternal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and The Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo”
  • , Tiziana MontalciniAffiliated withDepartment of Clinical and Experimental Medicine, University of Catanzaro
  • , Elisabetta BafferoAffiliated withInternal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and The Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo”
  • , Adriana GarzanitiAffiliated withDiabetes Unit. A.O. Province of Pavia
  • , Gabriele PelisseroAffiliated withDepartment of Internal Medicine, I.R.C.C.S. Policlinico San Donato
  • , Silvia CollavitiAffiliated withInternal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and The Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo”
  • , Annalisa GrugnettiAffiliated withInternal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and The Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo”
  • , Pietro GallottiAffiliated withInternal Medicine, Diabetes, Endocrine-Metabolic Diseases and Cardiovascular Prevention Unit and The Centre for Applied Clinical Research (Ce.R.C.A.), Clinical Institute “Beato Matteo”
    • , Arturo PujiaAffiliated withDepartment of Clinical and Experimental Medicine, University of Catanzaro
    • , Sebastiano B. SolerteAffiliated withDepartment of Internal Medicine, University of Pavia
    • , Andrea GiustinaAffiliated withDepartment of Medical and Surgical Sciences, University of Brescia

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Abstract

Neuropathy and peripheral artery disease represent the main pathophysiological conditions underlying diabetic foot. Several studies showed that Lipoprotein(a)—Lp(a)—and homocysteine (Hcy) can be associated with diabetic complications, but their relationship with diabetic foot is unclear. Aim of this study was to investigate whether Lp(a) and Hcy were associated with diabetic foot ulcerations, classified according to the presence of peripheral artery disease (PAD) or neuropathy. From among consecutive type 2 diabetic attending at the Diabetic Foot Clinic 27 subjects with vascular diabetic foot (VDF), 43 with neuropathic diabetic foot (NDF) and 52 controls without foot ulceration, neuropathy, and PAD were enrolled. Both Lp(a) (26.1 ± 22.7 vs. 14.9 ± 19.5 mg/dl; P = 0.003) and Hcy levels (15.4 ± 5.7 vs. 12.2 ± 5.1 μmol/l; P = 0.022) were significantly greater in the VDF group than in controls. Lp(a) levels were significantly lower in the NDF group than in controls (6.9 ± 8.1 versus 14.9 ± 19.5 mg/dl; P = 0.009), while no difference in Hcy levels was found. Multiple logistic regression analysis showed that Hcy was associated with VDF (OR: 1.11; 95% CI: 1.07–14.1; P = 0.048). Lp(a) did not enter the model, but its P-value was very near to the significant level (OR: 1.09; 95% CI: 0.99–12.05; P = 0.059). Moreover, low Lp(a) levels were associated with NDF (OR: 0.84; 95% CI: 0.21–0.96; P = 0.039). Our study has shown for the first time that high Lp(a) and Hcy levels are associated with the development of VDF, while low Lp(a) levels appear to be associated with delayed wound healing in patients with neuropathic foot ulcerations.

Keywords

Lipoprotein(a) Homocysteine Diabetic foot Diabetic neuropathy Peripheral artery disease