Elevated Lipoprotein(a) may increase risk of coronary heart disease among diabetes patients: Study

A new study published in the recent issue of Atherosclerosis journal showed that lipoprotein(a) [Lp(a)] levels may change the relationship between diabetes and coronary heart disease (CHD), or diabetes may change the relationship between Lp(a) and CHD in people without cardiovascular disease at baseline.

According to genetic epidemiology and observational data, Lp(a) is implicated in the development of atherosclerotic cardiovascular disease (ASCVD). The risk for ASCVD and calcific aortic valve stenosis seems to be linear and driven by proatherogenic, proinflammatory, and antifibrinolytic pathways, whereas circulating Lp(a) levels are mostly genetically dictated.

Diabetes is a risk factor for ASCVD on its own, and diabetics have a high lifetime risk of cardiovascular disease. Accordingly, statin medication is advised for all persons aged 40 to 75 who have diabetes and an LDL-C level of at least 70 mg/dL. This research indicates that Lp(a) is a significant risk factor for both diabetics and non-diabetics. Investigating the combined relationship between diabetes, Lp(a), and CHD in the Multi-Ethnic Study of Atherosclerosis (MESA), a sizable, multi-ethnic primary prevention cohort, was the aim of the current investigation.

A total of 6,668 people from the Multi-Ethnic Study of Atherosclerosis, a community-based cohort that did not have clinical cardiovascular disease at baseline, were included in the current research. The participants were divided into Groups 1 to 4 which were defined as follows: Lp(a) <50 mg/dL without diabetes, Lp(a) ≥50 mg/dL without diabetes, Lp(a) <50 mg/dL with diabetes, and Lp(a) ≥50 mg/dL with diabetes. 

Both diabetes and log[Lp(a)] were independently linked to CHD in a fully adjusted model. Diabetes and logLp(a) had a significant multiplicative interaction (p=0.033). In a fully adjusted model, individuals with Lp(a) ≥50mg/dL without diabetes (group 2) had a higher risk of CHD than the reference group (Lp(a) <50mg/dL without diabetes).

Likewise, those with diabetes (group 3) who had Lp(a) <50 mg/dL were likewise at higher risk for CHD. Those with diabetes and Lp(a) ≥50 mg/dL had the greatest risk for CHD. Overall, the findings imply that either diabetes may change the relationship between Lp(a) and CHD, or Lp(a) may change the relationship between diabetes and CHD.

Reference:

Rikhi, R., Haidar, A., Bhatia, H. S., Beam, K., McParland, J., Kazibwe, R., Chevli, P., Schaich, C. L., Sanghavi, M., & Shapiro, M. D. (2025). Association of lipoprotein(a) and diabetes in primary prevention of coronary heart disease: The multi-ethnic study of atherosclerosis (MESA). Atherosclerosis, 119179, 119179. https://doi.org/10.1016/j.atherosclerosis.2025.119179