Endocrine

, Volume 41, Issue 1, pp 89–95

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

Authors

    • Internal 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 MedicineI.R.C.C.S. Policlinico San Donato
  • Adriana Coppola
    • Internal 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 Montalcini
    • Department of Clinical and Experimental MedicineUniversity of Catanzaro
  • Elisabetta Baffero
    • Internal 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 Garzaniti
    • Diabetes Unit. A.O. Province of Pavia
  • Gabriele Pelissero
    • Department of Internal MedicineI.R.C.C.S. Policlinico San Donato
  • Silvia Collaviti
    • Internal 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 Grugnetti
    • Internal 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 Gallotti
    • Internal 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 Pujia
    • Department of Clinical and Experimental MedicineUniversity of Catanzaro
  • Sebastiano B. Solerte
    • Department of Internal MedicineUniversity of Pavia
  • Andrea Giustina
    • Department of Medical and Surgical SciencesUniversity of Brescia
Original Article

DOI: 10.1007/s12020-011-9544-4

Cite this article as:
Gazzaruso, C., Coppola, A., Montalcini, T. et al. Endocrine (2012) 41: 89. doi:10.1007/s12020-011-9544-4

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)HomocysteineDiabetic footDiabetic neuropathyPeripheral artery disease

Copyright information

© Springer Science+Business Media, LLC 2011