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15 February 1993 | Volume 118 Issue 4 | Pages 312-313
Ramirez and colleagues [1] have shown a relation between high Lp(a) levels and poor glycemic control in diabetic patients. They did not, however, include data on a major potential confounding factor—urinary protein excretion. Several investigators have documented a dramatic increase in Lp(a) levels in nondiabetic patients with heavy proteinuria as well as in diabetic patients with microalbuminuria [2-4]. Because the presence of diabetic nephropathy correlates with poor glycemic control [5], proteinuria was probably more prevalent in the patients with HbA1c levels greater than 8%. Does the association of poor glycemic control and high Lp(a) levels persist after controlling for elevated urinary protein excretion?
1. Ramirez LC, Arauz-Pacheco C, Lackner C, Albright G, Adams BV, Raskin P. Lipoprotein(a) levels in diabetes mellitus: relationship to metabolic control. Ann Intern Med. 1992; 117:42-7.
2. Karadi I, Romics L, Palos G, Doman J, Kaszas I, Hesz A, et al. Lp(a) lipoprotein concentration in serum of patients with heavy proteinuria of different origin. Clin Chem. 1989; 35:2121-3.
3. Joven J, Villabona C, Vilella E, Masana L, Simo JM. Abnormalities of lipoprotein metabolism in the nephrotic syndrome (Letter). N Engl J Med. 1991; 324:697-8.
4. Jenkins AJ, Steele JS, Janus ED, Best JD. Increased plasma apolipoprotein(a) levels in IDDM patients with microalbuminuria. Diabetes. 1991; 110:787-90.
5. Chase HP, Jackson WE, Hoops SL, Lockerham RS, Archer PG, O'Brien D. Glucose control and the renal and retinal complications of insulin-dependent diabetes. JAMA. 1989; 261:1155-60. About Letters
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
LETTER
Microalbuminuria, Lipoproteins, and Diabetic Control
TO THE EDITOR:
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