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Original investigation
Lipoprotein (a) Predicts Recurrent Worse Outcomes in Type 2 Diabetes Mellitus Patients with Prior Cardiovascular Events: A Prospective, Observational Cohort Study
Jian-Jun Li
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2536-4364
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Cardiovascular Diabetology.
Background: Merging studies have reported the association of lipoprotein(a) [Lp(a)] with poor outcomes of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, the prognostic importance of Lp(a) for recurrent cardiovascular events (CVEs) is currently undetermined in patients with T2DM and prior CVEs.
Methods: From April 2011 to March 2017, we consecutively recruited 2,284 T2DM patients with prior CVEs. Patients were categorized into low, medium, and high groups by Lp(a) levels and followed up for hard, recurrent CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Caplan-Meier, Cox regression and C-statistic analyses were performed.
Results: During 7,613 patient-years’ follow-up, 153 recurrent CVEs occurred. Lp(a) levels were significantly higher in patients with recurrent CVEs than counterparts (20.44 vs. 14.71 mg/dL, p=0.002). Kaplan–Meier analysis revealed that the event-free survival rate was dramatically lower in high and medium Lp(a) groups than that in low group irrespective of HBA1c status (<7.0%; ≥7.0%, both p<0.05). Furthermore, multivariate Cox regression models indicated that Lp(a) was independently associated with high risk of recurrent CVEs [HR(95% CI): 2.049(1.308-3.212)], such data remains in different HBA1c status (HR(95% CI): <7.0%, 2.009(1.051-3.840); ≥7.0%, 2.162(1.148-4.073)). Moreover, the results of C-statistic were significantly improved by 0.029 when added Lp(a) to the Cox model.
Conclusions: Our data, for the first time, confirmed that Lp(a) was an independent predictor for recurrent CVEs in T2DM patients with prior CVEs, suggesting that Lp(a) measurement may help to further risk stratification for T2DM patients after they suffered a first CVE.
Keywords
CAD, HBA1c, Lp(a), Recurrent CVEs, T2DM
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CURRENT STATUS: Published
Version 2
Posted 22 Jun, 2020
Published
On 09 Jul, 2020
No community comments so far
Editorial decision: Accept
On 23 Jun, 2020
Editor assigned
On 21 Jun, 2020
Submission checks complete
On 20 Jun, 2020
Editor invited
On 20 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 21 May, 2020
Review #2 received
Received 18 May, 2020
Review #4 received
Received 11 May, 2020
Review #3 received
Received 11 May, 2020
Review #1 received
Received 04 May, 2020
Reviewer #4 agreed
On 29 Apr, 2020
Editor assigned
On 28 Apr, 2020
Reviewers invited
Invitations sent on 28 Apr, 2020
Reviewer #1 agreed
On 28 Apr, 2020
Reviewer #2 agreed
On 28 Apr, 2020
Reviewer #3 agreed
On 28 Apr, 2020
Submission checks complete
On 27 Apr, 2020
Editor invited
On 27 Apr, 2020
First submitted
On 23 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
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Subject Areas
Endocrinology & Metabolism
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This preprint is under consideration at Cardiovascular Diabetology. A preprint is a preliminary version of a manuscript that has not completed peer review at a journal. Research Square does not conduct peer review prior to posting preprints. The posting of a preprint on this server should not be interpreted as an endorsement of its validity or suitability for dissemination as established information or for guiding clinical practice.
Learn more about In Review
Original investigation
Lipoprotein (a) Predicts Recurrent Worse Outcomes in Type 2 Diabetes Mellitus Patients with Prior Cardiovascular Events: A Prospective, Observational Cohort Study
Jian-Jun Li
Chinese Academy of Medical Sciences and Peking Union Medical College Fuwai Hospital
Corresponding Author
ORCiD: https://orcid.org/0000-0003-2536-4364
Badges
Prescreen
This manuscript passed our Prescreen assessment
Complete author information
Appropriate declaration statements
Potential risks to human health
Prescreen
Peer Review Timeline
CURRENT STATUS: Published
Version 2
Posted 22 Jun, 2020
Published
On 09 Jul, 2020
No community comments so far
Editorial decision: Accept
On 23 Jun, 2020
Editor assigned
On 21 Jun, 2020
Submission checks complete
On 20 Jun, 2020
Editor invited
On 20 Jun, 2020
No comments provided
Editorial decision: Major Revision
On 21 May, 2020
Review #2 received
Received 18 May, 2020
Review #4 received
Received 11 May, 2020
Review #3 received
Received 11 May, 2020
Review #1 received
Received 04 May, 2020
Reviewer #4 agreed
On 29 Apr, 2020
Editor assigned
On 28 Apr, 2020
Reviewers invited
Invitations sent on 28 Apr, 2020
Reviewer #1 agreed
On 28 Apr, 2020
Reviewer #2 agreed
On 28 Apr, 2020
Reviewer #3 agreed
On 28 Apr, 2020
Submission checks complete
On 27 Apr, 2020
Editor invited
On 27 Apr, 2020
First submitted
On 23 Apr, 2020
Metrics
Comments: 0
PDF Downloads: ...
HTML Views: ...
Subject Areas
Endocrinology & Metabolism
License:
This work is licensed under a CC BY 4.0 License. Read Full License
View the published version at Cardiovascular Diabetology.
Background: Merging studies have reported the association of lipoprotein(a) [Lp(a)] with poor outcomes of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM). However, the prognostic importance of Lp(a) for recurrent cardiovascular events (CVEs) is currently undetermined in patients with T2DM and prior CVEs.
Methods: From April 2011 to March 2017, we consecutively recruited 2,284 T2DM patients with prior CVEs. Patients were categorized into low, medium, and high groups by Lp(a) levels and followed up for hard, recurrent CVEs, including nonfatal acute myocardial infarction, stroke, and cardiovascular mortality. Caplan-Meier, Cox regression and C-statistic analyses were performed.
Results: During 7,613 patient-years’ follow-up, 153 recurrent CVEs occurred. Lp(a) levels were significantly higher in patients with recurrent CVEs than counterparts (20.44 vs. 14.71 mg/dL, p=0.002). Kaplan–Meier analysis revealed that the event-free survival rate was dramatically lower in high and medium Lp(a) groups than that in low group irrespective of HBA1c status (<7.0%; ≥7.0%, both p<0.05). Furthermore, multivariate Cox regression models indicated that Lp(a) was independently associated with high risk of recurrent CVEs [HR(95% CI): 2.049(1.308-3.212)], such data remains in different HBA1c status (HR(95% CI): <7.0%, 2.009(1.051-3.840); ≥7.0%, 2.162(1.148-4.073)). Moreover, the results of C-statistic were significantly improved by 0.029 when added Lp(a) to the Cox model.
Conclusions: Our data, for the first time, confirmed that Lp(a) was an independent predictor for recurrent CVEs in T2DM patients with prior CVEs, suggesting that Lp(a) measurement may help to further risk stratification for T2DM patients after they suffered a first CVE.
Figure 1
Figure 2
Figure 3