Influence and interaction of diabetes and lipoprotein (a) serum levels on mortality of patients with peripheral artery disease

• Published in: European journal of clinical investigation 2007-03, Vol.37 (3), p.180-186
• Main Authors: Maca, T., Mlekusch, W., Doweik, L., Budinsky, A.C., Bischof, M., Minar, E., Schillinger, M.
• Format: Article
• Language: English
• Subjects: Aged; Aged, 80 and over; Arteriosclerosis - blood; Arteriosclerosis - mortality; Biological and medical sciences; Diabetes mellitus; Diabetes Mellitus, Type 2 - blood; Diabetes Mellitus, Type 2 - mortality; Diabetes. Impaired glucose tolerance; Diabetic Angiopathies - blood; Diabetic Angiopathies - mortality; Endocrine pancreas. Apud cells (diseases); Endocrinopathies; Etiopathogenesis. Screening. Investigations. Target tissue resistance; Female; Follow-Up Studies; General aspects; Humans; lipoprotein (a); Lipoprotein(a) - metabolism; Male; Medical sciences; Middle Aged; mortality; peripheral artery disease; Peripheral Vascular Diseases - blood; Peripheral Vascular Diseases - mortality; Risk Factors
• ISSN: 0014-2972; 1365-2362
• DOI: 10.1111/j.1365-2362.2007.01747.x

Background  Diabetes mellitus is a risk factor for early complications and mortality in patients with peripheral artery disease. Lipoprotein (a) [Lp(a)] is also suggested to be a marker of increased cardiovascular risk. We investigated the association and interaction between diabetes mellitus, lipoprotein(a) and mortality in high risk patients with peripheral artery disease (PAD). Methods  We studied 700 consecutive patients [median age 73 years, interquartile range (IQR) 62–80, 393 male (56%)] with PAD from a registry database. Atherothrombotic risk factors (diabetes, smoking, hyperlipidaemia, arterial hypertension) and Lp(a) serum levels were recorded. We used stratified multivariate Cox proportional hazard analyses to assess the mortality risk at a given patient's age with respect to the presence of diabetes and Lp(a) serum levels (in tertiles). Results  Patients with Lp(a) levels above 36 mg dL−1 (highest tertile) and insulin‐dependent type II diabetes had a 3·01‐fold increased adjusted risk for death (95% confidence interval 1·28–6·64, P = 0·011) compared to patients without diabetes or patients with non‐insulin‐dependent type II diabetes. In patients with Lp(a) serum levels below 36 mg dL−1 (lower and middle tertile), diabetes mellitus was not associated with an increased risk for death. Conclusion  Insulin‐dependent type II diabetes mellitus seems to be associated with an increased risk for mortality in PAD patients with Lp(a) serum levels above 36 mg dL−1. PAD patients with non‐insulin‐dependent type II diabetes, and patients with diabetes and Lp(a) levels below 36 mg dL−1 showed survival rates comparable to PAD patients without diabetes.