Relationship of lipoprotein(a) with intimal medial thickness of the carotid artery in Type 2 diabetic patients in south India.

OBJECTIVE: The objective of this study was to investigate the association of lipoprotein(a) [Lp(a)] levels with intimal medial thickness (IMT) in Type 2 diabetic patients in south India. STUDY DESIGN: We studied 587 consecutive Type 2 diabetic patients at the M.V. Diabetes Specialities Centre, Chennai. The mean age of the study group was 55 +/- 10 years and 71.2% were males. IMT of the right common carotid artery was determined using high-resolution B mode ultrasonography. Lp(a) levels were measured using ELISA. Since the frequency distribution of Lp(a) was skewed, Lp(a) values were log transformed and the geometric mean was used for statistical analysis. The tertiles of IMT were determined to analyse the association of Lp(a) and other factors with IMT. RESULT: The mean Lp(a) level in the study patients was 18.9 +/- 3.1 mg/dl (geometric mean +/- sd) and the mean IMT of the study subjects was 0.93 +/- 0.19 mm (mean +/- sd). The prevalence of carotid atherosclerosis (defined as IMT > 1.1 mm) among subjects with elevated Lp(a) levels > 20 mg/dl was significantly higher compared with those with Lp(a) levels

Lipoprotein(a) in coronary heart disease: a case-control study.

To determine the significance of lipoprotein(a) levels in coronary heart disease patients, a case-control study was performed with 48 newly diagnosed coronary heart disease patients and 23 controls who were evaluated using clinical history and biochemical examination. Lipoprotein(a) was measured by quantitative latex-enhanced immunoturbidimetric method. Geometric means of biochemical parameters were obtained. Comprehensive lipid tetrad index was calculated using a previously validated formula. There was no significant difference in prevalence of diabetes, hypertension and smoking in cases and controls. Dietary intake of calories, fats, fatty acids and antioxidant vitamins was also similar. The levels of fasting glucose, cholesterol, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol and triglycerides were not significantly different in cases and controls (p > 0.05). Low-density lipoprotein/high-density lipoprotein ratio (4.33 +/- 1.5 vs 4.29 +/- 1.8) and total cholesterol/high-density lipoprotein ratio (6.59 + 1.7 vs 6.69 +/- 2.2) were similar. The mean lipoprotein(a) levels were significantly greater in cases (11.95 +/- 2.8 mg/dL, range 1-102 mg/dL) as compared to controls (6.68 +/- 3.4 mg/dL, range 1-73 mg/dL) (t = 2.08, p = 0.041). As compared to controls, in coronary heart disease cases, mean lipoprotein(a) levels in patients upto 50 years (10.27 +/- 2.8 vs 7.27 +/- 3.4 mg/dL) as well as those over 50 years (12.99 +/- 2.9 vs 4.91 +/- 3.5 mg/dL) were significantly more (p < 0.05). Coronary heart disease patients had a slightly greater prevalence of high lipoprotein(a) levels, 20 mg/dL or more (31.3 vs 13.0%; chi 2 = 2.83, l-tailed p < 0.05). Comprehensive lipid tetrad index (total cholesterol x triglycerides x lipoprotein(a) divided by high-density lipoprotein cholesterol) was also slightly higher in cases (14688.2 +/- 3.6) than in controls (8358.2 +/- 4.3) (t = 1.68, 1-tailed p < 0.05). This study shows that lipoprotein(a) levels are significantly more in both younger and older coronary heart disease patients as compared to controls.

Coronary artery disease epidemic in Indians: a cause for alarm and call for action.

Coronary artery disease (CAD) rates in urban areas in India are now 4-fold higher than in the United States (US) although the rates were similar in 1968. Both overseas and resident Indians have the highest rates of CAD, although almost half of them are life-long vegetarians. When compared to Whites, Blacks, Hispanics and other Asians, CAD rates among Indians worldwide are two to four times higher at all ages and five to ten times higher in those < 40 years of age. Although CAD is a fatal disease with no known cure, it is also highly predictable, preventable, and treatable. During the past 30 years, CAD rates halved in the US, Australia, Canada, France, Japan, and Finland. These vast reductions in CAD mortality are attributed to nationwide changes in specific risk factors that were identified through epidemiological research and addressed through population-based interventions, rather than extensive use of expensive technology. Reduction in risk factors explains most of the decline with modest contributions from advances in treatment. Ironically, the CAD rates doubled in India during the same period, primarily due to dietary changes associated with epidemiological transition from a rural sustenance economy to an urban market oriented economy. The impact of such changes appears to be greater in Indians than in other populations due to a genetic predisposition. Significant decline of CAD is readily achievable in India, by adopting a combined population-wide and high-risk primary prevention strategy. This requires concerted action by the medical profession, govemment, media, and the public.

Lipoprotein(a) is an independent risk factor for coronary artery disease in NIDDM patients in South India.

OBJECTIVE: Asian Indians have been reported to have very high prevalence rates of coronary artery disease (CAD) in the absence of traditional risk factors. Recently, elevated levels of lipoprotein(a) [Lp(a)] have been reported to be associated with premature CAD in migrant Asian Indians. However, there are very little data regarding Lp(a) in CAD patients from the Indian subcontinent and virtually none in individuals with NIDDM. The objective of this study was to assess the role of Lp(a) as a marker for CAD in South Indian NIDDM patients. RESEARCH DESIGN AND METHODS: We estimated serum Lp(a) in 100 control subjects, 100 NIDDM patients without CAD, and 100 NIDDM patients with CAD. Lp(a) values were transformed into natural logarithms. Statistical analysis included Student's t test, one-way analysis of variance, and chi2 test. Multiple logistic regression analysis was used to identify associations with CAD. RESULTS: Lp(a) levels were significantly higher in NIDDM patients with CAD compared with NIDDM patients without CAD and control subjects (geometric mean 24.6, 15.1, and 19.4 mg/dl, respectively, P < 0.05). Results of logistic regression analysis showed that Lp(a), age, and HDL were associated with CAD. In NIDDM patients with CAD, there was no correlation between Lp(a) and serum cholesterol, triglyceride, or HDL cholesterol levels, but there was a weak association with LDL cholesterol and systolic blood pressure. CONCLUSIONS: The data suggests that serum Lp(a) is an independent risk factor for CAD in NIDDM patients in South India.

Elevated lipoprotein(a) levels in South Asians in North America.

This report demonstrates that South Asians living in North America have elevated levels of Lp(a) compared with North American whites. Elevated Lp(a) levels may account, in part, for the tendency of South Asians to develop premature coronary heart disease (CHD).