Hong Kong Journal of Nephrology
Volume 13, Issue 1 , Pages 27-32, April 2011

Coronary Artery Disease Associated With Low-Grade Albuminuria in Type 2 Diabetes Mellitus

  • Paulo R. Mota

      Affiliations

    • Postgraduate Program in Public Health, Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
    • Diabetes and Hypertension Care Center, Ceará State Secretary of Health, Fortaleza, Ceará, Brazil
  • ,
  • Elizabeth F. Daher

      Affiliations

    • Department of Internal Medicine, Division of Nephrology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
    • Corresponding Author InformationCorrespondence to: Professor Elizabeth De Francesco Daher, Rua Vicente Linhares, 1198, Fortaleza, CE, Brasil CEP 60135-270
  • ,
  • Geraldo B. Silva Júnior

      Affiliations

    • Department of Internal Medicine, Division of Nephrology, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
    • School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
  • ,
  • JoséL Wellington O. Lima

      Affiliations

    • Department of Public Health, School of Medicine, State University of Ceará, Fortaleza, Ceará, Brazil
  • ,
  • Alexandre B. Libório

      Affiliations

    • School of Medicine, Health Sciences Center, University of Fortaleza, Fortaleza, Ceará, Brazil
  • ,
  • Adriana C. Forti

      Affiliations

    • Postgraduate Program in Public Health, Department of Community Health, School of Medicine, Federal University of Ceará, Fortaleza, Ceará, Brazil
    • Diabetes and Hypertension Care Center, Ceará State Secretary of Health, Fortaleza, Ceará, Brazil

Article Outline

Microalbuminuria can be measured in 24-hour urine samples for early detection of patients at high risk of developing vascular complications. The present study investigated the relation between vascular disease and normal levels of urinary albumin. The prevalence of coronary artery disease (CAD) and diabetic retinopathy (DR) was investigated in 145 patients with type 2 diabetes who had normal renal function. The patients were classified according to levels of microalbuminuria (normal ≤ 14 mg/24 hr, high-normal > 14 mg/24 hr to < 30 mg/24 hr). The association between CAD and DR and various patient parameters were investigated, including sex, age, time of diagnosis, family history of diabetes, smoking habits, body mass index, abdominal circumference, high blood pressure, absence of nocturnal blood pressure fall as registered by ambulatory 24-hour monitoring, retinopathy, total cholesterol, high-density lipoprotein cholesterol, low-density lipoprotein cholesterol, triglycerides, and glycosylated hemoglobin. The overall prevalence of CAD was 24.0% and that of DR was 18.3% among the 142 patients. A trend was observed toward an association of CAD with age > 60 years (p = 0.08) and family history of hypertension (p = 0.058). A significant association was found between CAD and high-normal microalbuminuria (relative risk 2.79; 95% confidence interval 1.88−4.16; p < 0.001). DR was statistically associated with female sex (p = 0.028) and duration of diagnosis > 5 years (p = 0.022). DR displayed a tendency for association with an absence of nocturnal blood pressure fall (p = 0.067), but was not statistically associated with either of the two levels of microalbuminuria (p = 0.657). CAD is significantly associated with the level of microalbuminuria > 14 mg/24 hr. The presence of DR could not be statistically associated with high-normal levels of microalbuminuria.

Key words:  association , coronary artery disease , diabetes mellitus , microalbuminuria , retinopathy

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References 

  1. Haffner SM , Letho S , Ronnemma T , Pyorala K , Laakso M . Mortality from coronary heart disease in subject with type 2 diabetes and in non diabetic subjects with and without myocardial infarction . N Engl J Med . 1998;339:229–234
  2. Sowers JR , Epstein M , Frohlich ED . Diabetes, hypertension, and cardiovascular disease . Hypertension . 2001;37:1053–1067
  3. Neaton JD , Wentworth D . Diabetes, other risk factors and 12-year cardiovascular mortality for men screened in the Multiple Risk Factor Intervention Trial . Diabetes Care . 1993;263:2335–2340
  4. Skyler J . Microvascular complications retinopathy and nephropathy . Endocrinol Metab Clin N Am . 2001;30:833–856
  5. Klein R , Klein BE , Moss SE , Cruikshanks KJ . Association of ocular disease and mortality in a diabetic population . Arch Ophthalmol . 1999;117:1487–1495
  6. Rajala U , Pajunpää H , Koskela P , S Keinänen-Kiukaanniemi . High cardiovascular disease mortality in subjects with visual impairment caused by diabetic retinopathy . Diabetes Care . 2001;23:957–961
  7. Pan CY , Ho LT , Soegondo S , Prodjosudjadi W , Suwanwalaikorn S , Lim SC , et al.   Prevalence of albuminuria and cardiovascular risk profile in a referred cohort of patients with type 2 diabetes: an Asian perspective . Diabetes Technol Ther . 2008;10:397–403
  8. Caramori ML , Fioretto P , Mauer M . The need for early predictors of diabetic nephropathy risk, is albumin excretion rate sufficient? . Diabetes . 2000;49:1339–1408
  9. Forsblom CM , Groop PH , Ekstrand A , Totterman KJ , Sane T , Saloranta C , et al.   Predictors of progression from normoalbuminuria to microalbuminuria in NIDDM . Diabetes Care . 2001;21:1932–1938
  10. Savge S , Estacio RO , Jeffers B , Schrier RW . Urinary albumin excretion as a predictor of diabetic retinopathy, neuropathy, nephropathy and cardiovascular disease in NIDDM . Diabetes Care . 1996;19:1243–1248
  11. Barkis GL . Microalbuminuria: What is it? Why is it important? What should be done about it? . J Clin Hyprtens . 2001;3:99–102
  12. American Diabetes Association  . Clinical practice recommendation, American Diabetes Association, 1999 . Diabetes Care . 2001;24:33–43
  13. Niskanen L , Penttilã I , Parviainen M , MIJ Uusitupa . Evolution, risk factors, and prognostic implications of albuminuria in NIDDM . Diabetes Care . 1996;19:486–493
  14. Ibsen H , Olsen MH , Wachtell K , Borch-Johnsen K , Lindholm LH , CE Mogensen . Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients with left ventricular hypertrophy and diabetes . J Nephrol . 2008;21:566–569
  15. Danziger J . Importance of low-grade albuminuria . Mayo Clin Proc . 2008;83:806–812
  16. Forman JP , Fisher ND , Schopick EL , Curhan GC . Higher levels of albuminuria within the normal range predict incident hypertension . J Am Soc Nephrol . 2008;19:1983–1988
  17. Wingard D , E Barret-Connor . Heart disease and diabetes . In: Diabetes in America . Washington, DC: U.S. Government Printing Office; 1995;p. 429–448
  18. Chavers BM , Bilous RW , Ellis EN , Steffes MW , Mauer SM . Glomerular lesions and urinary albumin excretion in type 1 diabetic patients without overt proteinuria . N Engl J Med . 1989;320:966–970
  19. Parving HH , Oxenboll B , Svendsen PA , Christiansen JS , Andersen AR . Early detection of patients at risk of developing diabetic nephropathy: a longitudinal study of urinary albumin excretion . Acta Endocrinol (Copen) . 1982;100:50–55
  20. Winnocur PH . Microalbuminuria . BMJ . 1992;304:1196–1197
  21. De Zeeuw D . Renal disease: a common and a silent killer . Nat Clin Pract Cardiovasc Med . 2008;5:S27–S35
  22. Vlek AL , van der Graaf Y , Spiering W , Algra A , Visseren FL , SMART Study Group  . Cardiovascular events and all-cause mortality by albuminuria and decreased glomerular filtration rate in patients with vascular disease . J Intern Med . 2008;264:351–360
  23. Bahrami H , Bluemke DA , Kronmal R , Bertoni AG , Lloyd-Jones DM , Shahar E , et al.   Novel metabolic risk factors for incident heart failure and their relationship with obesity: the MESA (Multi-Ethnic Study of Atherosclerosis) study . J Am Coll Cardiol . 2008;51:1775–1783
  24. Jassal SK , Langenberg C , von Mühlen D , Bergstrom J , E Barrett-Connor . Usefulness of microalbuminuria versus the metabolic syndrome as a predictor of cardiovascular disease in women and men > 40 years of age (from the Rancho Bernardo Study) . Am J Cardiol . 2008;101:1275–1280
  25. Ritz E . Metabolic syndrome and kidney disease . Blood Purif . 2008;26:59–62
  26. Vlek AL , van der Graaf Y , Spiering W , Algra A , Visseren FL , SMART Study Group  . Cardiovascular events and all-cause mortality by albuminuria and decreased glomerular filtration rate in patients with vascular disease . J Intern Med . 2008;264:351–360
  27. Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, et al  Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and non diabetic individuals . JAMA . 2001;286:421–426
  28. M MacLeod , J Lutale , M Marshall . Albumin excretion and vascular death in NIDDM . Diabetologia . 1995;38:610–616
  29. Kramer H , DR Jacobs , D Bild , W Post , MF Saad , R Detrano , et al.   Urine albumin excretion and subclinical cardiovascular disease: the multi-ethnic study of atherosclerosis . Hypertension . 2005;46:38–43
  30. Goldberg R . Risk factor modification for cardiac disease: cardiovascular disease in diabetic patients . Endocrinol Metab Clin . 2000;30:81–93
  31. Taylor A . Pathophysiology of hypertension and endothelial dysfunction in patients with diabetes mellitus . Endocrinol Metab Clin . 2001;30:1200–1214
  32. Stamler J , Vaccaro O , Neaton J , Wentworth D . Diabetes, other risk factors, and 12-yr cardiovascular mortality for men screened in the multiple risk factor intervention trial . Diabetes Care . 1993;16:434–444
  33. Curb JD , Pressel SL , Cutler JA , Savage PJ , Applegate WB , Black H , et al.   Effect of diuretic-based anti hypertensive treatment on cardiovascular risk in older diabetic patient with isolated systolic hypertension: Systolic Hypertension in the Elderly Program Cooperative Research Group . JAMA . 1996;276:1886–1892
  34. Tuomilehto J , Rastenyte D , Birkenhagen WH , Thijs L , Antikainen R , Bulpitt CJ , et al.   Effects of calcium-channel blockade in older patients with diabetes and systolic hypertension: Systolic Hypertension in Europe Trial Investigators . N Engl J Med . 1999;340:677–684
  35. De Boer IH , B Kestenbaum , TC Rue , MW Steffes , PA Cleary , ME Molitch , et al.   Insulin therapy, hyperglycemia, and hypertension in type 1 diabetes mellitus . Arch Intern Med . 2008;168:1867–1873
  36. Hiller R , Speroduto R , Podgor M , Ferris F , Wilson P . Diabetic retinopathy and cardiovascular disease in type 2 diabetics: the Framingham Heart Study and the Framingham Eye Study . Am J Epidemiol . 1988;128:402–409
  37. Torffvit O , Agardh E , Agardh CD . Albuminuria and associated medical risk factors: a cross-sectional study in 476 type 1 diabetic patient . J Diabetes Complications . 1991;5:23–28
  38. Wirta O , Pasternak A , Mustonem J , Lampalla P , Lahde V . Retinopathy is indepen dently associated to microalbuminuria in type 2 diabetes mellitus . Clin Nephrol . 1999;51:329–334

PII: S1561-5413(11)60004-5

doi:10.1016/S1561-5413(11)60004-5

Hong Kong Journal of Nephrology
Volume 13, Issue 1 , Pages 27-32, April 2011