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(Circulation. 1995;92:364-370.)
© 1995 American Heart Association, Inc.

Articles

HDLs Containing Apolipoproteins A-I and A-II (LpA-I:A-II) as Markers of Coronary Artery Disease in Men With Non–Insulin- Dependent Diabetes Mellitus

Mikko Syvänne, MD; Juhani Kahri, MD; Kari S. Virtanen, MD; Marja-Riitta Taskinen, MD

From the First (M.S., K.S.V.) and Third (J.K., M-R.T.) Departments of Medicine, Helsinki (Finland) University Central Hospital.

Correspondence and reprint requests to Dr Mikko Syvänne, First Department of Medicine, Helsinki University Central Hospital, Haartmaninkatu 4, FIN-00290 Helsinki, Finland.

Background Abnormalities in HDL and an increased risk of coronary artery disease (CAD) coexist in non–insulin-dependent diabetes mellitus (NIDDM). HDLs can be separated by their apolipoprotein (apo) content into particles containing apoA-I but not apoA-II (LpA-I) and those containing both apoA-I and apoA-II (LpA-I:A-II). The LpA-I particles have been suggested to be more effective in conferring protection against CAD than the LpA-I:A-II particles. However, data are sparse, and no studies have defined the role of these two classes of particles in NIDDM.

Methods and Results LpA-I and LpA-I:A-II particles were quantified by a differential electroimmunoassay in four groups of men with similar age and body mass index (BMI) distributions. Group 1 consisted of 50 patients with NIDDM and angiographically verified CAD; group 2, 50 men with CAD but no diabetes; group 3, 50 men with NIDDM but no CAD; and group 4, 31 healthy men. Serum apoA-I and apoA-II concentrations were measured by immunoturbidimetry, and HDL₂ and HDL₃ were separated by ultracentrifugation. Concentrations of LpA-I:A-II particles in group 1 were 13.8%, 18.3%, and 26.9% lower than in groups 2 through 4, respectively. In a two-by-two factorial ANOVA, adjusted for age and BMI, the differences were significant for both CAD (P<.001) and NIDDM (P<.001), with no interaction between the factors. These results were confirmed by comparable differences in the serum concentrations of apoA-I and apoA-II. LpA-I particles were related to the presence or absence of CAD (P=.013), but the difference was lost in a multivariate analysis. A low HDL₃ cholesterol concentration characterized both CAD (P=.002) and NIDDM (P=.024). HDL₂ cholesterol differed significantly with regard to the presence of NIDDM (P=.033) but only borderline with respect to CAD (P=.073).

Conclusions ApoA-II–containing lipoproteins and HDL₃ cholesterol are powerful markers of CAD in men with NIDDM.

Key Words: diabetes mellitus • lipoproteins • risk factors

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