Coronary artery disease, microalbuminuria and lipid profile in patients with non-insulin dependent diabetes mellitus

Abstract

Diabetes mellitus is an important factor associated with increased cardiovascular morbidity and mortality, due to coronary artery disease (CAD), stroke and peripheral vascular disease. Age adjusted coronary artery disease prevalence in diabetic patients, in the United States, is between 30 and 51%; peripheral vascular disease and stroke prevalences are 9 and 10%, respectively 1 . Recently, a study in Brazil reported a 2.3 greater in-hospital mortality rate in diabetic compared with nondiabetic patients, and the main cause of death was cardiovascular disease 2 .Today, it is recognized that the presence of microalbuminuria, in addition to being a marker of incipient renal disease in diabetic patients, seems to be also a marker of large vessel disease, and is associated with an increased cardiovascular disease mortality, especially coronary heart disease 3-5 . This increased mortality is due, in part, to a greater prevalence of other risk factors in patients with microalbuminuria, such as lipid disorders, hypertension (H), increased fibrinogen levels and blood rheology changes 6,7 . Recent studies from the World Health Organization demonstrated that the presence of proteinuria, in type 2 diabetic patients (DM2), increased the risk of cardiovascular death 3 to 4 times, independent of other risk factors 8 .The presence of microalbuminuria possibly reflects the process of generalized vascular damage, affecting simultaneously glomeruli, the retina and the intimal layer of large vessels. This has been demonstrated by studies of markers of endothelial dysfunction and measurements of transcapillary protein leakage 9,10 .Some studies suggested a common genetic predisposition for microalbuminuria and the early atherosclerotic process in diabetic patients 11 . Others suggested that glomerular mesangeal cells and arterial smooth muscle cells, being both of mesenchimal origin, would suffer the same changes in response to the different metabolic abnormalities observed in these patients, such as functional extracellular matrix changes with the consequent mesangial and medial proliferation, endothelial dysfunction and protein leakage 9 .The present study aimed to analyze the association between coronary artery disease, incipient diabetic renal

Hiperglicemia pós-prandial: tratamento do seu potencial aterogênico

“…Thus, prospective clinical assays with correction of postprandial hyperglycemia will be able to characterize the actual role of this control in the prevention of cardiovascular events. Notably, the presence of multiple associated risk factors in diabetic patients presupposes an intensive therapeutic intervention in these patients 39 .…”

Assessment of Asymptomatic Coronary Heart Disease in Type 2 Diabetics with Treadmill Test and Framingham 10-Year CHD Risk Scoring System

“…Another study found that cholesterol and triglyceride levels were elevated in 28 treadmill positive cases compared to 15 treadmill negative cases (p<0.01). 20 This study showed that significantly higher mean duration of diabetes (8.87 years) in TMT positive cases, in which 21.31%, 33.33%, 70% & 75% cases are of ≤5 years, 6-10 years, 11-15 years and 16-20 years of diabetes; respectively, suggestive that higher incidence of asymptomatic ischemic heart disease with prolong duration of diabetes. Above 10 years of duration of diabetes has 2 fold risk of developing asymptomatic ischemic heart disease in diabetic patients.…”

Avaliação do risco cardiovascular segundo os critérios de Framingham em pacientes com diabetes tipo 2

“…No entanto, consideramos que esse dado não acrescentaria informações relevantes, uma vez que qualquer paciente diabético tem uma pontuação maior no escore de Framingham do que o não-diabético (dois pontos para os homens e quatro para as mulheres diabéticas, versus zero para não-diabéticos). Além disso, a população diabética tem maior prevalência de HAS e dislipidemia, como já demonstrado em vários estudos (29)(30)(31), incluindo dados de nosso meio (32).…”