REPLY
Microalbuminuria, Lipoproteins, and Diabetic Control
Luis C. Ramirez and
Philip Raskin
15 February 1993 | Volume 118 Issue 4 | Pages 312-313
IN RESPONSE:
Drs. Bostom, Wilson, and Manske correctly point out the need to determine whether the association of poor diabetic control and high Lp(a) levels persists after controlling for an elevated urinary albumin excretion rate. Unfortunately, we did not measure urinary albumin excretion rates.
Lipoprotein(a) has a high degree of homology with plasminogen, a key protein of the fibrinolytic system [1]. It has been postulated that Lp(a) may compete with plasminogen at the level of the binding site and prevent fibrinolysis, thus promoting a procoagulant state [2]. We found no correlation, however, between Lp(a) levels and fibrinolysis in a group of patients with diabetes mellitus [3].
We and others have reported that normotensive patients with insulin-dependent diabetes mellitus and microalbuminuria have higher cholesterol and diastolic blood pressure levels than normoalbuminuric controls [4, 5]. However, a correlation between the level of diabetes control and the development of coronary artery disease in diabetics has not yet been shown.
We concur with Dr. Bostom regarding the need for a prospective study, but the undertaking would be enormous.
1. Eaton DL, Fless GM, Kohr WJ, McLean JW, Xu QT, Miller CG, et al. Partial amino acid sequences of apolipoprotein (a) shows that it is homologous to plasminogen. Proc Natl Acad Sci USA. 1987; 84.
2. Miles LA, Fless GM, Levin EG, Scanu AM, Plow EF. A potential basis for the thrombotic risks associated with lipoprotein (a). Nature. 1989; 339:301-3.
3. Arauz-Pacheco C, Ramirez LC, Pruneda L, Allison P. Relationship between fibrinolysis and lipoprotein (a) (Lp [a]), plasma lipids and glucose control in diabetes. Diabetes. 1992; 41(Suppl 1):112A.
4. Ramirez L, Rosenstock J, Arauz C, Hellenbrand D, Raskin P. Low prevalence of microalbuminuria in normotensive patients with insulin-dependent diabetes mellitus. Diabetes Res Clin Pract. 1991; 12:85-90.
5. Jensen T, Stender S, Deckert T. Abnormalities in plasma concentrations of lipoprotein and fibrinogen in type I (insulin-dependent) diabetic patients with increased urinary albumin excretion. Diabetologia. 1988; 31:141-5.
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