Gazzaruso Carmine, Garzaniti Adriana, Giordanetti Stefano, Falcone Colomba, Fratino Pietro
Internal Medicine Unit, IRCCS Maugeri Foundation Hospital, Pavia, Italy.
Cardiovasc Diabetol. 2002 Nov 22;1:5. doi: 10.1186/1475-2840-1-5.
There is little data on the relationship between novel cardiovascular risk factors and silent coronary artery disease (CAD) in diabetic patients. We investigated whether Lipoprotein(a), homocysteine and apolipoprotein(a) polymorphism are associated with angiographically assessed asymptomatic coronary artery disease (CAD) in diabetic patients.
1,971 type 2 diabetic patients without clinical signs of cardiovascular diseases and with a negative history of CAD were consecutively evaluated. Among them, 179 patients showed electrocardiographic abnormalities suggestive of ischemia or previous asymptomatic myocardial infarction. These 179 patients were subjected to a non-invasive test for CAD (ECG stress testing and/or scintigraphy). Among patients with a highly positive stress testing (n = 19) or a positive scintigraphy (n = 74), 75 showed an angiographically documented CAD (CAD group). Seventy-five patients without CAD (NO CAD group) were matched by age, sex and duration of diabetes to CAD patients. In NO CAD patients an exercise ECG test, a 48-hour ambulatory ECG and a stress echocardiogram were negative for CAD.
Lipoprotein(a) levels (22.0 +/- 18.9 versus 16.0 +/- 19.4 mg/dl; p < 0.05), homocysteine levels (13.6 +/- 6.6 versus 11.4 +/- 4.9 mmol/l; p < 0.05) and the percentage of subjects with at least one small apolipoprotein(a) isoform (70.7% versus 29.3%; p < 0.0001) were higher in CAD than NO CAD group. Logistic regression analysis showed that apolipoprotein(a) polymorphism (OR:8.65; 95%CI:3.05-24.55), microalbuminuria (OR:6.16; 95%CI:2.21-17.18), smoking (OR:2.53; 95%CI:1.05-6.08), HDL (OR:3.16; 95%CI:1.28-7.81), homocysteine (OR:2.25; 95%CI:1.14-4.43) and Lipoprotein(a) (OR:2.62; 95%CI:1.01-6.79) were independent predictors of asymptomatic CAD.
The present investigation shows an independent association of Lipoprotein(a), homocysteine and apo(a) polymorphism with silent CAD. Other studies are needed to establish whether these parameters are suitable for CAD screening in diabetic patients.
关于糖尿病患者中新发心血管危险因素与无症状冠状动脉疾病（CAD）之间关系的数据较少。我们研究了脂蛋白（a）、同型半胱氨酸和载脂蛋白（a）多态性是否与糖尿病患者经血管造影评估的无症状冠状动脉疾病（CAD）相关。
连续评估了1971例无心血管疾病临床体征且无CAD病史的2型糖尿病患者。其中，179例患者表现出提示缺血或既往无症状心肌梗死的心电图异常。这179例患者接受了CAD的无创检查（心电图负荷试验和/或闪烁扫描）。在负荷试验高度阳性的患者（n = 19）或闪烁扫描阳性的患者（n = 74）中，75例显示有血管造影记录的CAD（CAD组）。75例无CAD的患者（无CAD组）在年龄、性别和糖尿病病程方面与CAD患者相匹配。在无CAD患者中，运动心电图试验、48小时动态心电图和负荷超声心动图对CAD均为阴性。
CAD组的脂蛋白（a）水平（22.0±18.9对16.0±19.4mg/dl；p<0.05）、同型半胱氨酸水平（13.6±6.6对11.4±4.9mmol/l；p<0.05）以及至少有一种小载脂蛋白（a）异构体的受试者百分比（70.7%对29.3%；p<0.0001）均高于无CAD组。逻辑回归分析显示，载脂蛋白（a）多态性（OR：8.65；95%CI：3.05 - 24.55）、微量白蛋白尿（OR：6.16；95%CI：2.21 - 17.18）、吸烟（OR：2.53；95%CI：1.05 - 6.08）、高密度脂蛋白（HDL）（OR：3.16；95%CI：1.28 - 7.81）、同型半胱氨酸（OR：2.25；95%CI：1.14 - 4.43）和脂蛋白（a）（OR：2.62；95%CI：1.01 - 6.79）是无症状CAD的独立预测因素。
本研究表明脂蛋白（a）、同型半胱氨酸和载脂蛋白（a）多态性与无症状CAD存在独立关联。需要进一步研究以确定这些参数是否适用于糖尿病患者的CAD筛查。
