Summary
Patients with Type 2 (non-insulin-dependent) diabetes mellitus complicated by microalbuminuria or albuminuria, have an increased risk of developing macrovascular disease and of early mortality. Because lipoprotein abnormalities have been associated with diabetic nephropathy, this study tested the hypothesis that levels of apolipoprotein (a) are elevated in patients with Type 2 diabetes and increased levels of urinary albumin loss. Levels of apolipoprotein (a) in diabetic patients with microalbuminuria (n = 26, geometric mean 195 U/1, 95 % confidence interval 117–324) and albuminuria (n = 19, 281 U/1,165–479) were higher than in non-diabetic control subjects (n = 140,107 U/1, 85–134,p < 0.05), and in the albuminuric group than diabetic patients without urinary albumin loss (n = 58, 114 U/1, 76–169,p < 0.05). Patients with microalbuminuria and albuminuria had levels comparable with patients undergoing elective coronary artery graft surgery (n = 40,193 U/1,126–298). Apolipoprotein (a) levels were higher in diabetic patients with macrovascular disease than in those without (n = 49, 209 U/1, 143–306 vsn = 54, 116 U/1, 78–173,p < 0.05). These preliminary results suggest that raised apolipoprotein (a) levels of Type 2 diabetic patients with microalbuminuria and albuminuria may contribute to their propensity to macrovascular disease and early mortality.
Article PDF
Similar content being viewed by others
References
Mogensen CE (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes. N Engl J Med 310: 356–360
Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ (1984) Microalbuminuria predicts mortality in non-insulin-dependent diabetes. Diabetic Med 1: 17–19
Panzram G (1987) Mortality and survival in type 2 (non-insulin dependent) diabetes mellitus. Diabetologia 30: 123–131
Mattock MB, Keen H, Viberti GC et al. (1988) Coronary heart disease and urinary albumin excretion rate in type 2 (non-insulin-dependent) diabetic patients. Diabetologia 31: 82–87
Pyörälä K, Laakso M, Uusitupa M (1987) Diabetes and atherosclerosis: an epidemiologic view. Diabetes Metab Rev 3: 464–524
Utermann G (1989) The mysteries of lipoprotein (a). Science 246: 904–910
Jenkins AJ, Steele JS, Janus ED, Best JD (1991) Increased plasma apolipoprotein (a) levels in type 1 diabetic patients with microalbuminuria. Diabetes 40: 787–790
Winocour PH, Bhatnagar D, Ishola M, Arrol S, Durrington PN (1991) Lipoprotein (a) and microvascular disease in type 1 (insulin-dependent) diabetes. Diabetic Med 8: 922–927
Kapelrud H, Bangstad HJ, Dahl-Jorgensen K, Berg K, Hanssen KF (1991) Serum Lp (a) lipoprotein concentrations in insulin dependent diabetic patients with microalbuminuria. Br Med J 303: 675–678
National Diabetes Data Group (1979) Classification and diagnosis of diabetes mellitus and other categories of glucose intolerance. Diabetes 28: 1029–1057
Kostner GM (1990) The physiological role of Lp (a). In: Scanu A (ed) Lipoprotein (a). Academic Press, San Diego, pp 183–204
Dahlen GH (1990) Incidence of Lp (a) lipoprotein among populations. In: Scanu A (ed) Lipoprotein (a). Academic Press, San Diego, pp 151–173
Maeda S, Abe A, Seishima M, Makino K, Noma A, Kawade M (1989) Transient changes of serum lipoprotein (a) as an acute phase protein. Atherosclerosis 787: 145–150
Parra HJ, Mezdour H, Cachera C, Dracon M, Tacquet A, Fruchart JC (1987) Lp (a) lipoprotein in patients with chronic renal failure treated by hemodialysis. Clin Chem 33: 721
Albers JJ (1990) The measurement of Lp (a) and its clinical application. In: Scanu A (ed) Lipoprotein (a). Academic Press, San Diego, pp 141–149
Levitsky LL; Scanu AM, Gould SH (1991) Lipoprotein (a) levels in black and white children and adolescents with IDDM. Diabetes Care 14: 283–287
Bruckert E, Davidoff P, Grimaldi A et al. (1990) Increased serum levels of lipoprotein (a) in diabetes mellitus and their reduction with glycemic control. JAMA 263: 35–36 (Letter)
Haffner SM, Tuttle KR, Rainwater DL (1992) Lack of change of lipoprotein (a) concentration with improved glycemic control in subjects with type II diabetes. Metabolism 41: 116–120
Rees A, Bishop A, Morgan R (1990) The apo (a) gene: structure/function relationships and the possible link with thrombotic atheromatous disease. Br Med Bull 46: 873–890
Haffner SM, Moss SE, Klein BEK, Klein R (1992) Lack of association between lipoprotein (a) concentrations and coronary heart disease mortality in diabetes: the Wisconsin epidemiologic study of diabetic retinopathy. Metabolism 41: 194–197
Mbewu AD, Durrington PN (1990) Lipoprotein (a): structure, properties and possible involvement in thrombogenesis and atherogenesis. Atherosclerosis 85: 1–4
Rhoards GG, Dahlen G, Berg K, Morton NE, Darrenberg AL (1986) Lp (a) lipoprotein as a risk factor for myocardial infarction. JAMA 256: 2540–2544
Murai A, Mijahara T, Fujimoto N, Matsuda M, Kameyama M (1986) Lp (a) lipoprotein as a risk factor for coronary heart disease and cerebral infarction. Atherosclerosis 59: 199–204
Koltringer P, Jurgens G (1985) A dominant role of lipoprotein (a) in the investigation and evaluation of parameters indicating the development of cervical atherosclerosis. Atherosclerosis 58: 187–198
Loscalzo J (1990) Lipoprotein (a). A unique risk factor for atherothrombotic disease. Arteriosclerosis 10: 672–679
Cushing GL, Gaubatz JW, Nava ML et al. (1989) Quantitation and localization of apolipoproteins (a) and B in coronary artery bypass vein grafts resected at reoperation. Arteriosclerosis 9: 593–603
Miles LA, Fless GM, Levin EG, Scanu AM, Plow EF (1989) A potential basis for the thrombotic risks associated with lipoprotein (a). Nature (Lond) 339: 301–305
Yudkin JS, Forrest RD, Jackson CA (1988) Microalbuminuria as a predictor of vascular diseases in non-diabetic subjects. Lancet II: 530–533
Borch-Johnsen K, Kreiner S (1987) Proteinuria: value as predictor of cardiovascular mortality in insulin-dependent diabetes mellitus. Br Med J 294: 1651–1654
Black IW, Wilcken DEL (1992) Decreases in apolipoprotein (a) after renal transplantation: implications for lipoprotein (a) metabolism. Clin Chem 38: 353–357
Appel GB, Blum CB, Chien S, Kunis CL, Appel AS (1985) The hyperlipidaemia of the nephrotic syndrome. Relation to plasma albumin concentration, oncotic pressure, and viscosity. N Engl J Med 312: 1544–1548
Joven J, Villabona C, Vibella E, Masana L, Albert R, Valles M (1990) Abnormalities of lipoprotein metabolism inpatients with the nephrotic syndrome. N Engl J Med 323: 579–584
Karadl I, Romics L, Palos G et al. (1989) Lp (a) lipoprotein concentration in serum of patients with heavy proteinuria of different origin. Clin Chem 35: 2121–2123
Moorhead JF, Chan MK, El-Nahos M, Varghese Z (1982) Lipid nephrotoxicity in chronic progressive glomerular and tubulo-interstitial disease. Lancet 11: 1309–1311
Kasiske BL, O'Donnell MP, Cowardin W, Keane WF (1990) Lipids and the kidney. Hypertension 15: 443–450
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jenkins, A.J., Steele, J.S., Janus, E.D. et al. Plasma apolipoprotein (a) is increased in Type 2 (non-insulin-dependent) diabetic patients with microalbuminuria. Diabetologia 35, 1055–1059 (1992). https://doi.org/10.1007/BF02221681
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF02221681