Doença arterial coronariana e retinopatia em portadores de diabetes Mellitus 2 com níveis normais de albuminúria

Abstract

Cardiovascular disease is the main cause of morbidity and mortality in patients with diabetes mellitus. Measurement of microalbuminuria in urine at 24h (30-300 mg/24h) may be used for early detection of patients at high risk for development of vascular complications. According to a number of reports, submicroalbuminuric levei of albumin excretion in the urine is already a predictor of micro and macrovascular disease. In order to establish a relation between vascular disease and normal leveis of albuminuria, we analyzed the prevalence of Coronary Artery Disease (CAD) a macrovasculopathy and Diabetic Retinopathy (RD) a microvascular complication, with two leveis of albuminuria, the former termed ‘normal’ <= 14mg/24h, the latter ‘high normal’ > 14mg/24h, in 145 type 2 diabetic patients with normal renal function. We also studied the association between CAD and DR along with the association of high normal albuminuria with the variables gender, age, time of diagnosis, family history of diabetes, smoking habits, BMI, abdominal circumference, high blood pfessure, absence of nocturnal BP fali as registered by Ambulatory24-h BP monitoring, retinopathy, total cholesterol, HDL cholesterol, LDL cholesterol, triglycerides and glycohemoglobin. The overall prevalence of CAD was 24%, while that of DR was 18.3% for 142 patients. No statistically significant association was found between CAD and the variables included in the study. A tendency was observed towards an association with age over 60 years (£>=0.08) and with family history of hypertension (£>=0.058). A statistically significant association was found between CAD and high normal albuminuria (RR=2.79; 95% IC, 1.88-4.16; £><0.001). DR was statistically associated with female sex (£>=0.028), time of diagnosis over 5 years (£>=0.022), and displayed a tendency for association with absence of nocturnal BP fali (£>=0.067), but was not statistically associated with either of the two leveis of albuminuria (£>=0.657). No signifícant association was observed between albuminuria and the variables of the study. It may be concluded from the present fíndings, that of CAD is already significantly associated with normal leveis of albuminuria > 14mg/24h while the presence of DR cannot be statistically associated with high normal leveis of albuminuria.