Microalbuminuria and Cardiovascular Risk Factors in Type 2 Diabetes Mellitus

Abstract

Prospective studies have shown that increased urinary albumin excretion is a risk factor for cardiovascular morbidity and mortality in patients with Type 2 diabetes mellitus, but the nature of the association remains unknown. Eighty-five patients aged less than 65 years and not treated with insulin were studied. The overnight albumin excretion rate (AER) was measured in each patient and analysed in relation to several putative risk factors for cardiovascular disease. AER was used both as a continuous variable and after dividing patients into high-risk (AER greater than or equal to 10 micrograms min-1) and low-risk (AER less than 10 micrograms min-1) groups. By both methods of analysis AER was significantly correlated with both seated and supine diastolic blood pressure levels and with resting heart rate. Body mass index and waist-hip ratio appeared higher and HDL-cholesterol lower in the at-risk group, but differences were not statistically significant. The level of Factor VII was not significantly lower in the at-risk group. Little of the cardiovascular risk associated with raised AER can be attributed to associations with conventional risk factors.

Increased urinary albumin excretion and its associations in the WHO Multinational Study of Vascular Disease in Diabetes

“…The association of abnormal UAE with higher prevalence of coronary heart disease, stroke and lower-extremity amputation is consistent with other reports [4,5,27,36]. The expected associations between increased UAE and diabetic retinopathy was present in all centres and consistent with previous observations [4,22,26].…”

Increased Transcapillary Escape Rate of Albumin in Microalbuminuric Type II Diabetic Patients

“…More recently, these findings have been confirmed in two prospective studies (10,11) in which, besides diabetes duration, age, and glycemic levels (3,8,9), other major atherosclerotic risk factors, such as smoking, body weight, high blood pressure (BP) (12)(13)(14), and lipid and lipoprotein abnormalities (15,16) frequently associated with microalbuminuria, were taken into account.…”

“…Increased cardiovascular risk in type II diabetic patients with microalbuminuria cannot be merely attributed to coexisting risk factors, such as higher BP (7), obesity (7), unfavorable lipid profile and lipoprotein composition (12)(13)(14)(15), elevation in serum lipoprotein(a) concentrations (16), smoking (10), poorer glucose control (7), and disorders of the hemostatic system (44). Thus, other mechanisms must be examined to explain the higher susceptibility of type II diabetic patients with microalbuminuria toward macrovascular disease (45).…”

Associations between body morphology and microalbuminuria in healthy middle-aged European, Maori and Pacific Island New Zealanders

“…For example, the prevalence of microalbuminuria has been reported as 7±10% and 2±3%, in diabetic and non-diabetic European people, respectively. 18 By comparison, Allawi et al 5 reported microalbuminuria in 26% of Asian Indian people with NIDDM, Collins et al 6 reported prevalences of 26% in men and 30% in women from the Paci®c Island of Nauru, Haffner et al 8 reported a prevalence of microalbuminuria of 13% in non-diabetic Mexican Americans, Robbins et al 19 reported prevalences in American Indians of 28.3% in Arizona, 15.1% in Oklahoma and 13.8% in North and South Dakota, and we have reported prevalences of microalbuminuria in European, Maori, Paci®c Island and Asian New Zealanders of 2.7%, 15.6%, 13.0% and 8.0%, respectively. 15 There is no simple explanation for the ethnic differences in prevalences of microalbuminuria.…”