老年高血压患者的脂质状态分析

为观察老年高血病患者血脂水平变化特点,我们将合并CHD的老年高血压患者30例和有CHD、无高血压病的30例老年患者,配对分析总胆固醇(TC)、甘油三脂脂(TG)、低密度脂蛋白(LDL—C)、高密度脂蛋白(HDL—C)、载脂蛋白A及B(ApoA、ApoB)、及脂蛋白[a](Lp[a])的水平.结果显示对见察组比对照组,(总胆固醇)TC(222.5±40.0比181.2±40.0mg/dl)、(甘油三脂)TG(215.4±98.9比166.7±99.7mg/dl)、(低密度脂蛋白)LDL—C(152.8±31.6比112.6±34.6mg/dl)以及(载脂蛋白 B)ApoB(±1.060±0.266比0.833±0.263g/l)均明显为高(P<0.05—0.01).并且观察组的异常检出率在上述相应指标也多于对照组.结论:老年冠心病合并高血压患者容易出现脂质代谢紊乱.     

高脂血症患者血脂蛋白a水平的研究

目的　研究高脂血症 (HLP)患者血脂蛋白a[Lp(a) ]水平的变化。方法　用免疫比浊法测定 30例HLP患者血Lp(a) ,同时测定研究对象血胆固醇 (TC)、甘油三酯(TG)、高密度脂蛋白胆固醇 (HDL C)、低密度脂蛋白胆固醇(LDL C)、载脂蛋白AI(ApoA1)及载脂蛋白B(ApoB)。结果　HLP患者血Lp(a)显著高于对照组 (2 17 5± 14 5 3vs15 0 3± 14 9 8,P <0 0 5 )。HLP患者血Lp(a)与TC的相关系数为 0 6 4 3(P <0 0 1)。结论　HLP患者血Lp(a)明显升高 ,是冠心病 (CHD)、动脉粥样硬化 (AS)的危险因子。     

中老年人脂蛋白（a）流行情况与疾病关系（附500例临床分析）

对500例中老年患，用酶联免疫法测定Lp(a)血浆水平，研究中老年人Lp(a)流行情况及与疾病的关系。结果发现：(一)Lp(a)水平与性别．年龄无相关性，不随年龄增加而增高。多数研究认为30mg／dl作为临界值。本组500例中老年人群中Lp(a)>300mg／dl180例占36％．最高水平达170mg／dl,最低4mg／dl，个体间差异很大。在同一个体中Lp(a)水平相对恒定。一年中，163例曾两次以上测定Lp(a)值，其中109例Lp(a)值比较稳定，约占66％。Lp(a)水平与TC、TG、LDL．HDL之间无相关关系。(二)Lp(a)水平与疾病关系：中老年人常见疾病，心律失常，糖尿病、冠心病、心肌梗塞、高血压、脑血管病，各疾病之间Lp(a)水平无差别(P<005)。但病例组与对照组相比，Lp(a)水平明显增高(P<0．05)。当两组除去动脉粥样硬化其它危险因素(TC>220mg／dl，LDL>150mg／dl，HDL<45mg／d1)后，Lp(a)平均值两组相比，病例组(35.44±30.90)仍明显高于对照组(25．98±25．91)，P<0．05。提示Lp(a)水平增高是引起中老年人心脑血管动脉粥样硬的独立危险因素。     

高龄糖尿病患者动脉硬化性血管障碍与LP(a)的关系

Lipoprotein(a)[Lp(a)]是与动脉硬化性血管障碍有关的独立的危险因素,但对糖尿病患者或高龄者,其意义尚不明确,为此作者以在东京老年医疗中心内分泌科进行门诊治疗的354例60岁以上诊断为非依赖型胰岛素性糖尿病患者为研究对象进行分析。男性131例,女性223例,年龄60～97岁,平均年龄74.1岁。采用饮食疗法131例,药物疗法155例,胰岛素疗法68例。糖尿病病史13.6士9.9年,HtbAlc平均值7.7±1.4％。所有患者用EIA法测定Lp(a),同时测量身高、体重及安静坐位时血压,用Autoanalyzer测定空腹时血清脂质(血清总胆固醇:TC、中性脂肪:TG、HDL胆固醇:HDL—C和阿朴蛋白),用HPIC法测定HbAlc值,观察血清肌酸酐值与Lp(a)值关系。结果1)Lp(a)分布与年龄、性别的影响:高龄糖尿病患者Lp(a)平均值21.1±19.6mg/dl,中央值14.0mg/dl,非正规分布高值者少,为L字型分     

早发冠心病患者同胞及子女血脂与载脂蛋白E基因多态性研究

目的 :探讨早发冠心病患者同胞及子女与正常对照人群血脂分布特点、载脂蛋白E(apoE)基因型及其等位基因频率分布和对血脂的调节作用。方法 :检测早发冠心病患者的 72例同胞及子女 (病例组 )的血脂参数 ,应用聚合酶链反应及限制性片段长度多肽性分析各自的apoE基因型及其等位基因频率分布 ,并与 81例年龄相匹配并且父母和同胞无明显冠心病的对照者 (对照组 )进行比较。结果 :病例组血浆总胆固醇 (TC)和脂蛋白a[Lp(a) ]较对照组明显升高 [(4 .5 9± 1.6 1)mmol/L∶(4 .0 8± 1.0 2 )mmol/L ,P <0 .0 5 ;(2 41.88± 119.2 5 )mg/L∶(182 .2 4± 90 .2 0 )mg/L ,P <0 .0 1]。两组人群共有apoE基因型 6种 ,ε2 / 2 ,ε4/ 4和ε4/ 2为少见基因型。病例组ε4/ 3基因型和ε4等位基因频率明显高于对照组 (P <0 .0 5 )。病例组ε4/ 3基因型组血浆TC和低密度脂蛋白胆固醇 (LDL C)高于对应ε2 / 3组。病例组ε2 / 3基因型组血浆高密度脂蛋白胆固醇 (HDL C)高于对应ε4/ 3组。结论 :早发冠心病患者同胞及子女除了有早发冠心病家族史外 ,血浆TC、Lp(a)明显高于对照组 (P <0 .0 5～0 .0 1)。病例组ε4/ 3基因型和ε4等位基因频率明显高于对照组 (P <0 .0 5 ) ,并影响血浆TC、LDL C和HDL C的水平     

载脂蛋白E基因多态性与尼尔雌醇的调脂作用

目的　观察尼尔雌醇对绝经妇女的调脂作用与载脂蛋白E(apoE)基因多态性 ,以探讨遗传基因与药物效应的关系。　方法　对 94例绝经 2年以上的妇女按apoE等位基因分为 3组 :apoE2、E3、E4组 ,对其中 36例接受尼尔雌醇治疗的妇女与 5 8例未接受治疗的妇女进行血脂、载脂蛋白以及脂蛋白 (a)〔Lp(a)〕对照比较。　结果　治疗组与对照组比较 ,治疗组高密度脂蛋白 (HDL C)升高、低密度脂蛋白 (LDL C)以及Lp(a)降低 ,差异均有显著性 (P <0 0 5 )。从等位基因分组来看 ,接受治疗的E2组妇女表现为HDL C和TG升高、LD C降低 ,但与对照组比较差异无显著性。接受治疗的E3组妇女HDL C(2 7± 0 9)mmol L、LDL C(3 2± 1 0 )mmol L和Lp(a) (0 4± 0 2 )g L ,与对照组HDL C(1 7± 0 5 )mmol L和Lp(a) (0 5± 0 3)g L比较差异有显著性。接受治疗的E4组妇女表现HDL C(2 6± 1 0 )mmol L升高 ,LDL C(2 5± 1 6 )mmol L、TC(5 5± 0 7)mmol L降低 ,与对照组HDL C(1 4± 0 4 )mmol L、LDL C(4 0± 0 4 )mmol L比较差异有显著性 (P <0 0 5 )。　结论　绝经妇女使用长效、小剂量尼尔雌醇可以升高HDL C ,降低LDL C以及Lp(a) ,但apoE基因位点不同治疗效果不同 ,E4组妇女是心血管疾病的高危人群 ,激素替代治疗后 ,调脂     

2型糖尿病患者脂代谢紊乱与冠心病关系的探讨

目的　探讨 2型糖尿病患者脂代谢紊乱与冠心病的关系。方法　对 66例 2型糖尿病患者 (其中经冠脉造影确诊为冠心病者 45例 ,非冠心病者 2 1例 )进行全套血脂指标的测定并与对照组进行比较、分析。结果　与对照组相比 ,2型糖尿病并发冠心病患者高密度脂蛋白胆固醇(HDL C)水平降低 (P <0 .0 1) ,总胆固醇 (TC)、甘油三酯 (TG)、低密度脂蛋白胆固醇 (LDL C)及载脂蛋白B(ApoB)水平升高 (P <0 .0 5～ 0 .0 1) ,单纯 2型糖尿病患者TG、LDL C水平升高 ,HDL C水平降低 (P <0 .0 5～ 0 .0 1)。结论　HDL C水平的降低、TG、LDL C及ApoB水平的升高是 2型糖尿病并发冠心病的重要危险因素。尽早进行合理、有效的调脂治疗     

大豆异黄酮对冠心病患者血脂达标率的影响

目的　观察大豆异黄酮治疗冠心病伴高胆固醇血症患者的疗效 ,及其对血脂达标率的影响。方法　将 78例冠心病伴高胆固醇血症患者随机分为三组 ,各组 2 6例 ,每天分别给予辛伐他汀 2 0mg(辛伐他汀组 )、大豆异黄酮 15 0mg(异黄酮组 ) ,二药合用组 ,疗程为 8周。结果　辛伐他汀、大豆异黄酮均降低总胆固醇 (TC)、低密度脂蛋白 胆固醇 (LDL C)载脂蛋白B10 0 (ApoB10 0 )和脂蛋白 (a) [Lp(a) ] (P <0 .0 5及 0 .0 1) ;二药合用组TC、LDL C、降低效果明显优于各自单用药组 ,达标率明显提高 ( 69%比 2 3 %、19% ,P <0 .0 1) ,血清甘油三酯 (TG)降低 ,高密度脂蛋白 胆固醇 (HDL C)、载脂蛋白A1(ApoA1)升高 (P <0 .0 1)。结论　大豆异黄酮全面改善血脂 ,与他汀类合用效果更显著 ,并大幅度提高达标率。     

2型糖尿病患者血清脂蛋白(a)水平变化及其意义

用免疫透射比浊法测定30例正常人、30例冠心病患者和80例2型糖尿病患者的血清Lp(a)水平,并分析它与2型糖尿病其他代谢指标间的关系.DM患者分为2组①无肾病(NDN)组50;②肾病(DN)组30例.结果①NDN和正常人血清Lp(a)水平无显著性差异[(179.55±53.71)mg/L Vs(150.35±34.02)mg/L,P＞0.05);而DN Lp(a)水平((339.87±42.77)mg/L]显著高于NDN和正常人(P＜0.05);②DM患者中,血清Lp(a)水平与Upro呈简单正相关关系(r=0.35,P＜0.05).结论①NDN,血清Lp(a)水平与非糖尿病患者相比无显著性差异;②DN患者出现血清Lp(a)水平显著增高,且与尿蛋白呈正相关关系,提示Lp(a)水平升高可能继发于DN的肾脏损害,随肾脏损害进展而逐步升高.     

冠心病患者血清脂蛋白（a）的临床研究

观察227例冠心病患者血清脂蛋白(a)[Lp(a)]的变化。结果显示:1.冠心病患者Lp(a)水平明显高于正常人。2.急性心肌梗塞患者Lp(a)水平增高者,再梗塞人数,心律失常、泵衰发生率及病死率增高。3.Lp(a)增高时,血清总胆固醇(Ch)、低密度脂蛋白胆固醇(LDL—C)、极低密度脂蛋白胆固醇(VLDL—C)、载脂蛋白ApoB增高,三酸甘油脂(TG)下降。4.Lp(a)随年龄增长,尤女性明显。当Lp(a)大于300mg/L时此种增长更显著。年龄小于55岁时男性Lp(a)水平高于女性,而年龄>55岁者,女性高于男性。     

Relation of lipoprotein(a) as coronary risk factor to type 2 diabetes mellitus and low-density lipoprotein cholesterol in patients > or =65 years of age (The Italian Longitudinal Study on Aging)

High levels of serum lipoprotein(a) [Lp(a)] have been associated with increased risk of coronary artery disease (CAD), but this association apparently is not confirmed in elderly people. We evaluated the interactions of Lp(a) with lipid and nonlipid CAD risk factors in a sample of subjects enrolled in the prevalence survey (1992 to 1993) of the Italian Longitudinal Study on Aging (ILSA). The entire population consisted of 5,632 elderly people, aged 65 to 84 years, randomly selected in 8 Italian municipalities. The present cross-sectional study included 400 free-living elderly subjects (74 +/- 6 years) from the randomized cohort of Casamassima (Bari, Southern Italy) (n = 704). The results showed that in the elderly population, high serum Lp(a) is a CAD risk factor dependent on type 2 diabetes mellitus and elevated low-density lipoprotein (LDL) cholesterol levels. In particular, the combined effect of high Lp(a) (> or =20 mg/dl) and high LDL cholesterol (> or =3.63 mmol/L [> or =140 mg/dl]), increases coronary risk by 2.75 (95% confidence interval 7.70 to 0.99); finally, the effect of Lp(a) > or =20 mg/dl and LDL cholesterol > or =3.63 mmol/L (> or =140 mg/dl), combined with type 2 diabetes mellitus, increases risk of CAD by 6.65 (95% confidence interval 35.40 to 1.25). In the elderly, elevated Lp(a) levels appear not to be an independent predictor of CAD, but this lipoprotein is a risk factor only in subjects with type 2 diabetes mellitus and elevated LDL cholesterol.     

Lack of association of serum lipoprotein (a) levels with type-2 diabetes mellitus in patients with angiographically defined coronary artery disease

Multiple studies have demonstrated that elevated serum lipoprotein (a) [Lp(a)] levels are independent predictors for coronary artery disease (CAD) in subjects without diabetes mellitus (DM). However, their contribution in patients with DM is controversial and still requires clarification. We determined serum Lp(a) levels in 355 consecutive Caucasian patients (271 men and 84 women) with angiographically documented CAD, and in 100 control subjects (58 men and 42 women) who were clinically free of cardiovascular disease. In addition, the association of serum Lp(a) levels with type-2 DM in patients with CAD was investigated after reassigning patients according to the diagnosis of type-2 DM (61 men and 40 women with type-2 DM and 210 men and 44 women without). No gender differences in Lp(a) levels were observed between men and women (patients and control subjects). Patients with CAD had higher Lp(a) levels than the control subjects (33 (14-74) vs. 13 (9-29) mg/dl, P<0.001). Elevated Lp(a) levels (defined as >90th percentile of controls) were significantly more prevalent in men and women with CAD (35% and 28%, respectively) than in control subjects (13% and 10%, respectively). Serum Lp(a) levels correlated with LDL cholesterol (r=0.22, P<0.001) and apo B levels (r=0.18, P<0.03) in patients and control subjects. Stepwise discriminant analysis revealed that Lp(a) was an independent risk factor for the presence of CAD, independent of smoking, hypertension, type-2 DM, LDL and HDL cholesterol or apo A1 and B levels. When patients were studied according to the spread of CAD (evaluated as the number of narrowed vessels), no differences in serum Lp(a) levels were observed, nor was there a higher prevalence of elevated Lp(a) levels. Finally, when patients were re-assigned according to the diagnosis of type-2 DM, no effect of apo B and LDL-C levels on Lp(a) was found (r=0.06, P=n.s. and 40.14, P=n.s., respectively) and serum Lp(a) levels neither associated nor contributed to the extent of CAD. Our results showed that serum Lp(a) levels are increased in patients with angiographically documented CAD, but there were no significant differences between diabetic and non-diabetic patients, which indicates that elevated Lp(a) levels are specifically associated with CAD but not with type-2 DM.     

Dyslipidemias with desirable plasma total cholesterol levels and angiographically demonstrated coronary artery disease

The National Cholesterol Education Program treatment guidelines define a plasma total cholesterol of less than 200 mg/dl as "desirable" and recommend no further evaluation of plasma lipid or lipoprotein levels in patients with coronary artery disease (CAD). To determine the prevalence of dyslipidemias in the presence of coexistent CAD and total cholesterol less than or equal to 200 mg/dl, a retrospective case-control study of 1,000 patients who underwent diagnostic coronary angiography was performed. Of 351 patients with total cholesterol less than or equal to 200 mg/dl, 76% of the men (244) and 44% of the women (107) had angiographically demonstrated CAD. In men with CAD and total cholesterol less than or equal to 200 mg/dl, there was a significantly greater prevalence of low levels of high density lipoprotein (HDL) cholesterol (less than or equal to 35 mg/dl), age greater than 50 years, systemic hypertension and diabetes mellitus compared to non-CAD control subjects. In women with CAD and total cholesterol less than or equal to 200 mg/dl, HDL cholesterol less than or equal to 45 mg/dl and diabetes mellitus were also significantly prevalent. Multiple logistic regression analyses revealed that HDL cholesterol, hypertension and age in men and very low density lipoprotein cholesterol in women were significantly associated with CAD after adjustment for other risk factors. These results suggest that a complete lipid and lipoprotein analysis be obtained in all patients with CAD, irrespective of the plasma (or serum) total cholesterol level.     

Efficacy and tolerability of combined treatment with L-carnitine and simvastatin in lowering lipoprotein(a) serum levels in patients with type 2 diabetes mellitus

Lipoprotein(a) [Lp(a)] concentration is generally related to coronary artery disease (CAD) and cerebrovascular disease. However, at present, few interventions are available to lower Lp(a) concentrations. We investigated the effects of l-carnitine, co-administered with simvastatin, on hyper-Lp(a) in patients with type 2 diabetes mellitus. We conducted an open, randomised, parallel-group study, in one investigational center (University hospital). Fifty-two patients with type 2 diabetes mellitus, a triglyceride serum levels <400mg/dL (<4.5 mmol/L), and Lp(a) serum levels >20mg/dL (0.71 mmol/L) were randomised to receive simvastatin alone (n=26) or simvastatin plus l-carnitine (n=26) for 60 days. Simvastatin was administered, in both groups, at a dosage of 20 mg/day, while l-carnitine was administered at a dosage of 2g/day once daily. Both treatments were given orally. Serum levels of triglycerides, total cholesterol, LDL cholesterol, high-density lipoprotein (HDL) cholesterol, non-HDL cholesterol (total cholesterol minus HDL cholesterol), apolipoprotein B, and Lp(a) were measured at baseline and 60 days after starting treatment. No difference in time by groups (simvastatin and simvastatin plus l-carnitine) were observed in the reduction of LDL cholesterol, non-HDL cholesterol, and apoB serum levels. On the other hand, Lp(a) serum levels increase from baseline to 60 days in the simvastatin group alone versus a significant decrease in the combination group. Our findings provide support for a possible role of combined treatment with l-carnitine and simvastatin in lowering Lp(a) serum levels in patients with type 2 diabetes mellitus than with simvastatin alone. Our results strongly suggest that l-carnitine may have a role among lipid-lowering strategies.     

Serum lipoprotein (a) levels in patients with diabetic foot lesions

Our aim was to see the levels of lipoprotein (a) (Lp (a)) in patients with gangrenous or non-gangrenous diabetic foot lesions. Twenty-two patients with gangrenous foot lesions, 11 with non-gangrenous foot lesions and 10 healthy subjects were included in the study. All the patients had similar glycemic control and duration of diabetes. The main outcome measure was serum Lp (a) levels in both group of patients with diabetes and healthy subjects. Diabetic patients with gangrenous foot lesions had significantly higher Lp (a) levels (83.8+/-8.3 mg/dl) than the patients with non-gangrenous foot lesions (38.3+/-5.8 mg/dl) and healthy subjects (35.6+/-4.2 mg/dl). Lp (a) levels were not significantly different in healthy subjects and in patients with non-gangrenous foot lesions. Lp (a) levels may have a pathogenetic role in the development of gangrenous foot lesions in patients with diabetes mellitus.     

糖化和糖氧化低密度脂蛋白与糖尿病合并颈动脉粥样硬化的关系

目的　观察糖化低密度脂蛋白 (Gly LDL)和糖氧化低密度脂蛋白 (Gly ox LDL)与非胰岛素依赖型糖尿病(NIDDM)合并颈动脉粥样硬化 (AS)的关系。方法　Gly LDL采用微柱亲和层析法。Gly ox LDL采用微柱亲和层析加荧光分光光度法观察。NIDDM合并颈AS者 (病例 1组 ) 30例 ,无糖尿病的颈AS者 (病例 2组 ) 4 8例。对照组 32例。结果　两病例亚组Gly LDL和Gly ox LDL含量显著高于对照组 (P均 <0 .0 5 )。病例 1组Gly LDL和Gly ox LDL含量显著高于病例 2组 (P <0 .0 5 )。结论　Gly LDL和Gly ox LDL在颈AS中起重要作用 ,尤其在糖尿病病人颈AS形成中起重要作用。     

血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的相关性

目的探讨血清YKL-40水平与2型糖尿病患者冠状动脉病变程度的关系。方法选择因心绞痛行冠状动脉造影的2型糖尿病患者197例,根据造影结果,冠状动脉正常为对照组(n=89),冠状动脉病变为冠心病组(n=108)。根据冠状动脉病变支数分为单支病变、双支病变和三支病变;Gensini积分评价冠状动脉病变狭窄程度。ELISA测定血清YKL-40和高敏C反应蛋白水平(hs-CRP)。结果冠心病组和对照组间血清YKL-40、hs-CRP、收缩压、总胆固醇、低密度脂蛋白胆固醇、载脂蛋白B、脂蛋白(a)、餐后2 h血糖、糖化血红蛋白水平及吸烟率存在明显的差异(P<0.05)。不同冠状动脉病变支数组血清YKL-40水平和Gensini积分存在显著差异(P<0.01);血清YKL-40与Gensini积分存在明显相关性(r=0.611,P<0.01)。Logistic回归分析显示,血清YKL-40是2型糖尿病患者罹患冠心病的危险因素(OR=1.229,95%CI为1.086～1.427,P=0.003)。结论 YKL-40可能参与2型糖尿病粥样硬化的发生发展过程,血清YKL-40水平与2型糖尿病患者冠状动脉病变的严重性相关。     

Clinical evaluation of plasma high-density lipoprotein subfractions (HDL2, HDL3) in non-insulin-dependent diabetics with coronary artery disease

STATEMENT OF THE PROBLEM: Low levels of high-density lipoprotein cholesterol (HDL-C) have a strong association with coronary artery disease (CAD) in patients with non-insulin-dependent diabetes mellitus (NIDDM). In this study, we tried to evaluate whether one or both of the major HDL subclasses (HDL2, HDL3) is strongly associated with the risk of CAD in NIDDM subjects. METHODS: The separation of HDL subclasses was carried out by ultracentrifugation in a Beckman Airfuge. HDL2 subclass was isolated from the supernatant and its cholesterol content was measured enzymatically. Plasma HDL3 cholesterol was calculated as the difference between results for total HDL cholesterol and HDL2 cholesterol. RESULTS: NIDDM patients with CAD had significantly higher triglyceride levels compared to either control (217.09+/-55.04 versus 89.62+/-31.29 mg/dl, P=.001) or CAD patients without NIDDM (217.09+/-55.04 versus 156.28+/-46.39 mg/dl, P<.05). However, in the diabetic patients with CAD, there was a statistically significant decrease in HDL cholesterol (39.63+/-8.59 versus 55.86+/-13.49 mg/dl, P<.01), HDL2 cholesterol (8.74+/-3.28 versus 16.95+/-5.73 mg/dl, P<.001), and HDL3 cholesterol (31.23+/-7.41 versus 38.91+/-8.93 mg/dl, P<.05) in comparison to nondiabetic controls. Moreover, in the comparison between non-insulin-dependent diabetics with CAD and CAD subjects without NIDDM, HDL cholesterol (39.63+/-8.59 versus 46.13+/-6.33 mg/dl, P<.05) and HDL2 cholesterol (8.74+/-3.28 versus 11.84+/-4.01 mg/dl, P<.02) were significantly reduced, while HDL3 cholesterol levels were (31.23+/-7.41 versus 34.29+/-7.94 mg/dl, P=.92) unaltered. Additionally, the percentage reduction of cholesterol in HDL2 fraction was proportionately greater than the decrease in HDL3 subclass in both comparisons. Moreover, in NIDDM with CAD, HDL cholesterol was reduced by 29% and 14%, HDL2 cholesterol by 48% and 26%, and HDL3 cholesterol by 20% and 9%, compared relatively to controls and CAD subjects without NIDDM. CONCLUSIONS: In conclusion, HDL2 is the more variable subclass and reflects changes in HDL. This suggests that the protective role of total HDL against CAD is mainly mediated through HDL2 fraction. Therefore, HDL2 might be a better predictor of coronary heart disease than total HDL, in non-insulin-dependent diabetes mellitus.     

Association of lipoprotein(a) levels and apolipoprotein(a) phenotypes with coronary artery disease in Type 2 diabetic patients and in non-diabetic subjects.

AIMS: We investigated whether in Type 2 diabetic patients lipoprotein(a) (Lp(a)) levels and apolipoprotein(a) (apo(a)) polymorphism are associated with angiographically documented coronary artery disease (CAD). We also examined whether there are differences in the distributions of Lp(a) levels and apo(a) phenotypes between CAD patients with and without diabetes. METHODS: A hundred and seven diabetic patients with CAD, 274 diabetic patients without CAD, 201 non-diabetic patients with CAD, and 358 controls were enrolled. RESULTS: Diabetic patients with CAD showed Lp(a) levels (21.2 +/- 17.7 vs. 15.1 +/- 17.8 mg/dl; P = 0.0018) and a percentage of subjects with at least one apo(a) isoform of low molecular weight (MW) (67.2% vs. 27.7%; P = 0.0000) significantly greater than diabetic patients without CAD. Multivariate analysis showed that in diabetic patients Lp(a) levels and apo(a) phenotypes were significantly associated with CAD; odds ratios (ORs) of high Lp(a) levels for CAD were 2.17 (1.28-3.66), while ORs of the presence of at least one apo(a) isoform of low MW were 5.35 (3.30-8.60). Lp(a) levels (30.2 +/- 23.7 vs. 21.2 +/- 17.7 mg/dl; P = 0.0005) and the percentage of subjects with at least one apo(a) isoform of low MW (87.0% vs. 67.2%; P = 0.0001) were significantly higher in CAD patients without than in those with diabetes. CONCLUSIONS: Our data suggest that Lp(a) levels and apo(a) phenotypes are independently associated with CAD in Type 2 diabetic patients; thus both these parameters may be helpful in selecting diabetic subjects at high genetic cardiovascular risk. However, Lp(a) levels and apo(a) polymorphism seem to be cardiovascular risk factors less important in diabetic than in non-diabetic subjects. Diabet. Med. 18, 589-594 (2001)     

Short-Term and Long-Term Effects of Low-Density Lipoprotein (LDL) Apheresis on Restenosis after Percutaneous Transluminal Coronary Angioplasty (PTCA): Is Lowering Lp(a) by LDL Apheresis Effective on Restenosis after PTCA?

Abstract: It has been reported that serum lipoprotein(a) (Lp[a]) levels in patients with restenosis after percutaneous transluminal coronary angioplasty (PTCA) were significantly higher than in patients without restenosis. In this study, we evaluated the preventive effect of LDL apheresis on restenosis after PTCA in patients with hypercholesterolemia. For 10 patients who had shown a serum cholesterol level of more than 220 mg/dl despite treatment with antihypercholesterolemic drugs, LDL apheresis was conducted every 2 weeks after a successful PTCA until restenosis could be checked. In 4 patients, LDL apheresis was conducted for 2 years. LDL apheresis significantly reduced serum cholesterol from 248 ± 22 mg/dl to 135 ± 26 mg/dl and Lp(a) from 42 ± 34 mg/dl to 21 ± 16 mg/dl. The average degree of stenosis in the 11 lesions undergoing PTCA was 92 ± 6% before PTCA, 35 ± 10% immediately after PTCA, and 38 ± 19% at 3 to 4 months after PTCA. Restenosis was observed in only 1 lesion. In 4 patients who received LDL apheresis for 2 years, restenosis did not occur in any of the 4 lesions treated. We concluded that LDL apheresis was an efficacious therapy to prevent restenosis after PTCA in patients with hypercholesterolemia.