Endocrine Abstracts

Background: LPa is an established independent risk factor for atherosclerotic cardiovascular disease (ASCVD). There is currently no consensus regarding the need for routine LPa measurement in T1DM patients in UK clinical practice, despite evidence suggesting that high LPa is a significant risk factor in T1DM that may relate to poor metabolic control and vascular complications.

Methods: T1DM patients attending a hospital clinic underwent LPa testing during their annual review blood tests. The group was divided into tertiles according to LPa levels (low, 0-30, intermediate, 30-120 and high, >120nmol/l) and associations between LPa and clinical and metabolic characteristics were then explored. Those with high LPa levels were individually assessed to ascertain how LPa measurement had impacted on clinical management.

Results (mean±SD): For all patients (n = 96) (49M, 47F), age was 52±16yrs, diabetes duration, 29±17yrs, HbA1c 62±14mmol/mol, non-HDL-C 2.7±0.92mmol/L and LPa 24(10-59)nmol/l (median (IQR)). Frequency (%) of complications was 13(ASCVD), 41(hypertension), 59(retinopathy), 18(nephropathy). 63% received statins and 7% were smokers. LPa levels correlated with non-HDL-C (r = .21, P < 0.05) but not with HbA1c nor micro/macro-vascular disease status. Those with high LPa levels (11%) were more likely to have a family history of ASCVD (X²17.2, P < 0.01). Amongst the high LPa group, clinical management of cardiovascular risk factors was impacted by the LPa result in 82% of patients. In 7% of cases, LPa>200nmol/l.

Conclusion: LPa levels were not related to either glycaemia or vascular complications in our T1DM cohort, although those with higher LPa levels were more likely to have a family history of ASCVD. High LPa levels were present in a significant proportion of patients leading to intensification of cardiovascular risk factor management in the majority of those cases. LPa measurement in T1DM serves as a useful clinical tool to refine cardiovascular risk stratification.