1 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet2 Graduate School of Health and Medical Sciences, Faculty of Health and Medical Sciences, Københavns Universitet3 Graduate School of Health and Medical Sciences, Faculty of Health and Medical Sciences, Københavns Universitet4 Department of Clinical Medicine, Department of Clinical Medicine, Faculty of Health and Medical Sciences, Københavns Universitet
a Mendelian randomisation study
BACKGROUND: Low concentrations of lipoprotein(a) in plasma are associated with increased risk of type 2 diabetes, but whether this association is causal is unclear. Variations in the LPA gene affect lipoprotein(a) isoform size and concentrations in plasma. We therefore did a Mendelian randomisation study to investigate whether large isoform size, low concentrations in plasma, or both, are causally associated with type 2 diabetes. METHODS: We assessed data for adults from the Danish general population enrolled in the Copenhagen City Heart Study and the Copenhagen General Population Study, with and without type 2 diabetes. Eligible participants had data for lipoprotein(a) concentrations in plasma, LPA kringle IV type 2 (KIV-2) sums of repeats (affecting both isoform size and plasma concentrations), and carrier status for the LPA single-nucleotide polymorphism rs10455872 (mainly affecting concentrations in plasma). FINDINGS: 77,901 individuals had lipoprotein(a) data, of whom 28,567 (36·7%) had all three measurements. Low concentrations of lipoprotein(a) in plasma were associated with risk of type 2 diabetes, with adjusted odds ratios of 1·26 (1·09-1·45), 1·17 (1·01-1·36), 1·04 (0·90-1·21), and 1·05 (95% CI 0·90-1·22), respectively, for quintiles 1-4, compared with quintile 5 concentrations. High KIV-2 sums of repeats were associated with risk of type 2 diabetes (adjusted odds ratio 1·16, 95% CI 1·05-1·28) for KIV-2 quintile 5 versus quintiles 1-4 combined. Being a carrier of rs10455872 did not affect risk of type 2 diabetes. For a halving of lipoprotein(a) concentrations, the instrumental variable estimate of the causal odds ratio for type 2 diabetes was 1·15 (95% CI 1·05-1·27) for KIV-2 sum of repeats and 0·99 (0·95-1·03) for rs10455872 genotype. INTERPRETATION: Low lipoprotein(a) concentrations alone seem not to be causally associated with type 2 diabetes, but a causal association for large lipoprotein(a) isoform size cannot be excluded. FUNDING: Danish Heart Foundation, Danish Council for Independent Research-Medical Sciences, IMK Almene Fund, and Johan and Lise Boserup's Fund.
Lancet Diabetes and Endocrinology, 2013, Vol 1, Issue 3, p. 220-227