Is inverse association between lipoprotein(a) and diabetes mellitus another paradox in cardiometabolic medicine?

IF 2.7 Q3 ENDOCRINOLOGY & METABOLISM Expert Review of Endocrinology & Metabolism Pub Date : 2024-01-01 DOI:10.1080/17446651.2023.2293108

Donatos Tsamoulis, Constantine E Kosmas, Loukianos S Rallidis

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Abstract

Introduction: The impact of Type II Diabetes mellitus (T2DM) on cardiovascular disease (CVD) is well-established, while lipoprotein(a) [Lp(a)] has recently emerged as a recognized CVD risk factor. The rising prevalence of T2DM resulting from modern lifestyles and the development of specific Lp(a)-lowering agents brought the association between T2DM and Lp(a) in the forefront.

Areas covered: Despite advancements in T2DM treatment, diabetic patients remain at very-high risk of CVD. Lp(a) may, to some extent, contribute to the persistent CVD risk seen in diabetic patients, and the coexistence of T2DM and elevated Lp(a) levels appears to synergistically amplify overall CVD risk. The relationship between T2DM and Lp(a) is paradoxical. On one hand, high Lp(a) plasma concentrations elevate the risk of diabetic microvascular and macrovascular complications. On the other hand, low Lp(a) plasma concentrations have been linked to an increased risk of developing T2DM.

Expert opinion: Comprehending the association between T2DM and Lp(a) is critical due to the pivotal roles both entities play in overall CVD risk, as well as the unique aspects of their relationship. The mechanisms underlying the inverse association between T2DM and Lp(a) remain incompletely understood, necessitating further meticulous research.

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脂蛋白（a）与糖尿病之间的反向关联是心血管代谢医学中的另一个悖论吗？

导言：II 型糖尿病（T2DM）对心血管疾病（CVD）的影响已得到公认，而脂蛋白（a）[Lp(a)] 近来已成为公认的心血管疾病风险因素。现代生活方式导致 T2DM 患病率上升，以及降脂蛋白（a）特效药物的开发，使 T2DM 与脂蛋白（a）之间的关系成为人们关注的焦点：尽管 T2DM 的治疗取得了进展，但糖尿病患者仍然面临着极高的心血管疾病风险。脂蛋白（a）可能在一定程度上导致了糖尿病患者持续的心血管疾病风险，而 T2DM 和脂蛋白（a）水平升高同时存在似乎会协同放大整体心血管疾病风险。T2DM 和脂蛋白（a）之间的关系是矛盾的。一方面，血浆中高浓度的脂蛋白（a）会增加糖尿病微血管和大血管并发症的风险。另一方面，低脂蛋白（a）血浆浓度与 T2DM 的发病风险增加有关：专家观点：了解 T2DM 与脂蛋白（a）之间的关联至关重要，因为这两种物质在整体心血管疾病风险中发挥着关键作用，而且它们之间的关系具有独特性。T2DM与脂蛋白（a）之间的反向关联机制仍不完全清楚，需要进一步细致研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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Expert Review of Endocrinology & Metabolism ENDOCRINOLOGY & METABOLISM-

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4.80

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期刊介绍： Implicated in a plethora of regulatory dysfunctions involving growth and development, metabolism, electrolyte balances and reproduction, endocrine disruption is one of the highest priority research topics in the world. As a result, we are now in a position to better detect, characterize and overcome the damage mediated by adverse interaction with the endocrine system. Expert Review of Endocrinology and Metabolism (ISSN 1744-6651), provides extensive coverage of state-of-the-art research and clinical advancements in the field of endocrine control and metabolism, with a focus on screening, prevention, diagnostics, existing and novel therapeutics, as well as related molecular genetics, pathophysiology and epidemiology.