Enhanced independent discriminative performance of elevated lipoprotein(a) for cardiovascular outcomes in patients with diabetes: a comparative analysis of optimal cutoff values.

Song Wen, Yanju He, Xiucai Li, Zhimin Xu, Dan Liu, Jiyu Li, Ligang Zhou

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Article in Frontiers in endocrinology, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.

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7 authors.

Song WenDepartment of Endocrinology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China.

Yanju HeDepartment of Endocrinology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China.

Xiucai LiDepartment of Endocrinology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China.

Zhimin XuDepartment of Endocrinology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China.

Dan LiuDepartment of Rheumatology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China.

Jiyu LiDepartment of Surgery, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China.

Ligang ZhouDepartment of Endocrinology, Shanghai Pudong Hospital, Fudan University, Pudong Medical Center, Shanghai, China.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

Objective: This study aimed to evaluate the independent discriminative performance of elevated Lipoprotein(a) [Lp(a)] in identifying prevalent cardiovascular disease (CVD), specifically in patients with Diabetes Mellitus (DM), and to determine the optimal cutoff values for identifying CVD in the DM population. Methods: A stratified analysis was conducted across general, DM, and non-DM patient groups. Correlation analysis was employed to assess the association between elevated Lp(a) levels and metabolic factors in different age groups. Furthermore, binary regression was used to calculate combined risk scores. Receiver operating characteristic (ROC) curve analysis was utilized to determine the area under the curve (AUC) for the discriminative performance of Lp(a) alone, traditional parameters (excluding Lp(a)), and the combined model. This analysis identified the optimal cutoff values for each group. Results: Comparisons of Lp(a) variations showed that Lp(a)>300mg/L was associated with an increased prevalence of CVDs in general and non-diabetic patients, while it was insignificant in patients with DM, unless the cutoff was set as low as 70mg/L; Correlation analyses showed that, regardless of minor nuances between the general and DM groups, Lp(a) was significantly related to Low-density lipoprotein (LDL) and Apolipoprotein B (ApoB), but negatively related to Glycated Hemoglobin A1c (HbA1c), Triglycerides (TG), and free triiodothyronine (FT3); when stratified by age, no correlation was associated with Lp(a), but an association was found with CVD in the 65-75 age group, while Non-alcoholic fatty liver disease (NAFLD) prevalence was higher in the <65 age group across groups except for Lp(a)>70mg/L in the DM group; correlational analyses revealed that Lp(a) was positively related with CVD in the <65 age group compared to the general group. Regression analyses revealed that HbA1c and age significantly contributed to increased CVD in DM and that Lp(a) was determined by FT3 and albumin (Alb) in DM; ROC curves demonstrated that the combination of Lp(a) with traditional parameters significantly enhanced the AUC for CVD in DM. Conclusion: Elevated Lp(a) levels are significantly associated with CVD and demonstrate strong discriminative utility, particularly in patients with DM. These findings suggest that more stringent Lp(a) thresholds may be warranted in the clinical management of diabetic patients to better identify individuals at high risk for cardiovascular outcomes.

Indexed as

BiomarkersCardiovascular DiseasesDiabetes MellitusDiabetes Mellitus, Type 2Lipoprotein(a)AdultAgedFemaleHumansMaleMiddle AgedPrognosisRisk FactorsROC CurveBiomarkersLipoprotein(a)cardiovascular diseases (CVD)cutoffdiabetes mellitusLp(a)risk stratification

Identifiers

PMID42095175

DOI10.3389/fendo.2026.1795181

PMCPMC13138970

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