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Microalbuminuria, Lipoproteins, and Diabetic Control
- Luis C. Ramirez, MD; and
- Philip Raskin, MD
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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.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
