Lipoprotein(a) in South Indian type 2 diabetic subjects in relation to diabetic vascular complications.

OBJECTIVES: Lipoprotein(a) [LP(a)] has been reported to be an independent risk factor for coronary artery disease (CAD). However, its relationship with other vascular complications is not clear. The aim of the study was to determine the relation of lipoprotein(a) with micro- and macrovascular complications seen in type 2 diabetic patients. METHODS: We studied 725 type 2 diabetic patients with and without diabetic complications at the MV Diabetes Specialities Centre, Chennai. The mean age of the study group was 54 +/- 10 years and 70% were males. Diabetic complications viz retinopathy, proteinuria, peripheral vascular disease and coronary artery disease were diagnosed using standardized definitions. Lipoprotein(a) levels were measured using enzyme linked immunosorbant assay (ELISA). Since the frequency distribution of Lp(a) was skewed Lp(a) values were log transformed and geometric mean was used for statistical analysis. RESULTS: The mean Lp(a) level of patients with any vascular complication was significantly higher compared to the subjects without any complications. Multiple logistic regression analysis revealed that lipoprotein(a) had as independent association with CAD (Odds Ratio -1.16, p=0.04) and proteinuria (Odds Ratio -1.69, p < 0.001). The association of Lp(a) with retinopathy and PVD turned out to be non-significant when CAD and proteinuria was introduced as cofactors in the regression model. CONCLUSION: Lp(a) concentrations are found to be higher in those with CAD and proteinuria. There appears to be no association between Lp(a) and retinopathy or PVD in South Indian type 2 diabetic patients.

Churg-Strauss syndrome in patients receiving montelukast as treatment for asthma.

STUDY OBJECTIVES: We previously reported eight patients who developed Churg-Strauss syndrome in association with zafirlukast treatment for asthma and postulated that the syndrome resulted from unmasking of a previously existing condition due to corticosteroid withdrawal and not from a direct drug effect. The availability of montelukast, a new leukotriene receptor antagonist with a different molecular structure, permitted us to test this hypothesis. Our goals were to ascertain whether the Churg-Strauss syndrome developed in patients taking montelukast and other novel asthma medications, and to describe potential mechanisms for the syndrome. DESIGN: Case series. SETTING: Outpatient and hospital practices of pulmonologists in the United States and Belgium. PATIENTS: Four adults (one man, three women) who received montelukast as treatment for asthma; two women who received salmeterol/fluticasone therapy, but not montelukast. RESULTS: Churg-Strauss syndrome developed in the four asthmatic patients who received montelukast. In each case, there was a long history of difficult-to-control asthma characterized by multiple exacerbations that had required frequent courses of oral systemic corticosteroids or high doses of inhaled corticosteroids for control. Two other asthmatics who received fluticasone and salmeterol but not montelukast therapy developed the same syndrome with tapering doses of oral or high doses of inhaled corticosteroids. CONCLUSIONS: The occurrence of Churg-Strauss syndrome in asthmatic patients receiving leukotriene modifiers appears to be related to unmasking of an underlying vasculitic syndrome that is initially clinically recognized as moderate to severe asthma and treated with corticosteroids. Montelukast does not appear to directly cause the syndrome in these patients.

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.