Lipoprotein(a) and NAFLD linked to non fatal MI in Diabetic Individuals, finds study

The retrospective study, using data from the National Health and Nutrition Examination Survey (NHANES) III, revealed that individuals with diabetes were more likely to report a history of myocardial infarction (MI) if they also had high levels of serum lipoprotein(a), or Lp(a), or advanced liver fibrosis.

"Multivariate analysis showed that the risk for a non-fatal MI more than doubled when levels reached 50 mg/dL, a level that current guidelines consider to be elevated, and beyond, compared with diabetes patients with the lowest Lp(a) levels (<10 mg/dL)," Avica Atri, MD, of Jefferson Einstein Hospital in Philadelphia, reported at the annual American Association of Clinical Endocrinology (AACE).

As well, advanced liver fibrosis associated with NAFLD was linked with a 70% higher risk for a non-fatal MI (aOR 1.70).

Patients who self-reported a history of myocardial infarction had higher Lp(a) levels than those who did not report an MI (mean 30.7 versus 24.2 mg/dL, respectively) and were more likely to have advanced liver fibrosis (13.5% versus 4.5%).

The patients with advanced liver fibrosis tended to have lower mean Lp(a) levels versus those without advanced fibrosis (13.6 versus 25.9 mg/dL), even among the subset with a prior MI (8.6 versus 34.2 mg/dL).

Diabetes mellitus, a chronic metabolic disorder characterized by elevated blood sugar levels, is known to significantly increase the risk of cardiovascular diseases, including myocardial infarction. However, the specific mechanisms underlying this heightened risk have remained a subject of extensive research.

Lp(a) is produced by the liver circulating levels in the body are determined by genetics. It is an established independent risk factor for atherosclerotic cardiovascular disease (ASCVD). Growing evidence suggests NAFLD is linked with heart disease as well, the relationship between Lp(a), NAFLD, and the MI risk has not been studied well in patients with diabetes mellitus.

The cross-sectional analysis presented by Atri included a weighted sample of 3,330,795 people with diabetes ages 35 and older from the NHANES III database (1988 to 1994) who had Lp(a) data collected.

The mean participants' age was 62 years; 59% were women, and the median HbA1c was 7.7%. Non-fatal MI prevalence was 13.3%. 18% of patients met the criteria for advanced liver fibrosis associated with NAFLD (a score of 2.67 on the Fibrosis-4 scale).

A higher proportion of patients in the MI group had lipoprotein (a) levels over 50 mg/dL (about 30% versus 19% in those without an MI).

The study's limitations included its cross-sectional nature and that because it is based on interviews, there is a possibility of recall bias. Furthermore, given the study design, fatal MIs could not be assessed for an association with Lp(a) or advanced liver fibrosis.

Reference:

Atri A "Association between serum lipoprotein(a), NAFLD and risk of non-fatal myocardial infarction in individuals with diabetes mellitus" AACE 2024.