Endocrine Abstracts

Introduction: The 2019 European Society of Cardiology/European Atherosclerosis Society lipid guidelines changed the cardiovascular risk categories and LDL-C goals, and suggests that lipoprotein(a) [Lp(a)] measurement should be considered at least once in adult person’s lifetime. Although young people with type 1 diabetes (T1DM) without major cardiovascular risk factors (CVRF) were previously considered to be at low or moderate risk, they are at least at moderate risk based on the best available evidence. Emerging studies suggest that increased Lp(a) levels are associated with poor metabolic control in patients with T1DM. However, the knowledge about Lp(a) in T1DM is still limited.

Objectives: To evaluate the application of these guidelines and to investigate the association of Lp(a) and metabolic control in young adults with T1DM.

Methods: Observational cross-sectional study, including young adults (18–40 years) with T1DM. Patients with Lp(a) measurements were divided into two groups: very low-intermediate Lp(a) levels ( ≤ 120) vs high (> 120 nmol/l).

Results: Included 75 T1DM patients (61.3% male), with median age of 30.9 (26.0–36.0) years, T1DM duration of 13.0 (6.0–20.0) years and HbA1c 7.7 (7.1–8.8)%. Median LDL-C was 105.0 (85.0–128.0) mg/dl. Among 9/75 (12.0%) patients at moderate risk (T1DM aged < 35 and T1DM duration < 10 years, without other CVRF), 1 (11.1%) had LDL-C above the target (≥ 100 mg/dl). Of the 44/75 (58.7%) at high risk (DM ≥ 10 years, without target organ damage or another CVRF), 38 (86.4%) had LDL-C ≥ 70 mg/dl. Among 22/75 (29.3%) patients at very high risk [DM with target organ damage, at least 3 major CVRF or early onset of T1DM of long duration (> 20 years)], all were above LDL-C goal (≥ 55 mg/dl). Median Lp(a) was 17.0 (6.0–39.0) nmol/l (n = 54), no patients had extremely high levels (> 430 nmol/l). Among patients not treated with antidyslipidemics, 3/48 (6.3%) had high Lp(a) levels [all at high risk and with LDL-C above the recommended goal (≥ 70 mg/dl)]. Patients with high Lp(a) levels had significantly higher body mass index (P = 0.042), high-sensitivity C-reactive protein (P = 0.041), total cholesterol (P = 0.014), LDL-C (P = 0.002) and non-HDL-C (P = 0.003); and a trend to higher HbA1c and apolipoprotein B/AI ratio (both P = 0.054). Lp(a) levels did not differ according to metabolic control (HbA1c < 6.9 vs ≥ 6.9%). By the logistic regression method, none of the studied variables was predictive of high Lp(a) levels.

Conclusion: This study suggests that Lp(a) is a high risk marker in young adults with T1DM. Routine Lp(a) measurement in clinical practice could improve their cardiovascular risk assessment and justify intensive treatment.