Prospective Study of Microalbuminuria as Predictor of Mortality in NIDDM

Mattock, M. B.; Morrish, Nicholas J.; Viberti, Giancarlo; Keen, H.; Fitzgerald, Anthony P.; Jackson, Gordon

doi:10.2337/diab.41.6.736

Cited by 289 publications

(70 citation statements)

References 27 publications

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“…The adverse metabolic profile associated with albuminuria supports reports indicating albuminuria is a major independent predictor of future vascular events [36]. Similarly, in this study, the ACR was a major independent predictor of the presence of MCA stenosis in these diabetic patients.…”

Section: Discussionsupporting

confidence: 78%

Middle Cerebral Artery Stenosis in Type II Diabetic Chinese Patients Is Associated with Conventional Risk Factors but Not with Polymorphisms of the Renin-Angiotensin System Genes

et al. 2003

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Background: Conventional and genetic risk factors have been reported to play a role in the pathogenesis of ischaemic stroke, and differences may explain the heterogeneity of disease presentation in different populations. In Chinese, middle cerebral artery (MCA) stenosis is the most commonly identified intracranial vascular lesion. The involvement of renin-angiotensin system (RAS) gene polymorphisms in this condition has not been determined. Objectives: To determine whether conventional and RAS genetic vascular risk factors are associated with MCA stenosis, asymptomatic Chinese type II diabetic patients with and without MCA stenosis matched for age, gender and diabetes duration were compared. Methods: Biochemical parameters and the genotype and allele frequencies of three RAS gene polymorphisms, the angiotensin-converting enzyme (ACE) insertion/deletion, angiotensinogen (AGT) M235T and angiotensin II type 1 receptor (AT₁R) A1166C polymorphisms were then compared between 217 diabetics with and 490 matched diabetic controls without MCA stenosis selected from 2,202 diabetics. Results: MCA stenosis was associated with significantly increased systolic blood pressure, LDL-cholesterol and albuminuria, yet diastolic blood pressure and glucose levels were lower. There was an increased prevalence of hypertension and use of blood pressure-lowering agents in the MCA stenosis patients. Albuminuria was also more commonly found in these patients. Hypertensive status, systolic blood pressure and albuminuria were strong, independent predictors of the presence of MCA stenosis. No differences in the RAS polymorphism distributions were observed between patients with and without MCA stenosis. Conclusions: In these asymptomatic type II diabetics, blood pressure indices and albuminuria, but not RAS gene polymorphism, were closely associated with MCA stenosis.

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Section: Discussionsupporting

confidence: 78%

Middle Cerebral Artery Stenosis in Type II Diabetic Chinese Patients Is Associated with Conventional Risk Factors but Not with Polymorphisms of the Renin-Angiotensin System Genes

et al. 2003

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“…Microalbuminuria is an independent risk factor for mortality both in healthy [40] and T2DM patients [41]. It is also an index of increased cardiovascular vulnerability.…”

Section: High Risk Conditions Associated With Diabetesmentioning

confidence: 99%

Cardiovascular risk assessment in patients with diabetes

Bertoluci

Rocha

2017

Diabetol Metab Syndr

186

123

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Although patients with diabetes have 2 to 4 times increased risk of cardiovascular morbidity and mortality than individuals without diabetes, recent studies indicate that a significant part of patients are in a lower cardiovascular risk category. Men younger than 35 years, women younger than 45 years, patients with diabetes duration of less than 10 years without other risk factors have a much lower risk than patients who have traditional cardiovascular risk factors, and subclinical or established coronary artery disease (CAD). These patients are not risk equivalent as stated in previous studies. On the contrary, when in the presence of traditional risk factors or evidence of subclinical coronary disease (e.g. high coronary calcium score), the coronary risk is much increased and patients may be classified at a higher-risk category. Recent guidelines do not anymore consider diabetes as a CAD risk equivalent and recommend cardiovascular risk stratification for primary prevention. Stratification of diabetic patients improves accuracy in prediction of subclinical CAD, silent ischemia and future cardiovascular events. Stratification also discriminates higher from lower risk patients who may need intensive statin or aspirin prevention, while avoiding overtreatment in lower risk cases. It may also allow the clinician to decide whether to intensify risk reduction actions through specific newer drugs for glucose control such as SGLT-2 inhibitors or GLP-1 agonists, which recently have shown additional cardiovascular protector effect. This review addresses the assessment of cardiovascular disease risk using traditional and non-traditional cardiovascular risk factors. It also reviews the use of risk calculators and new reclassification tools, focusing on the detection of subclinical atherosclerosis as well as silent ischemia in the asymptomatic patients with diabetes.

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“…Diabetic nephropathy is a major cause of premature morbidity and mortality in both insulin-dependent diabetes mellitus (IDDM) and non-insulin-dependent diabetes mellitus (NIDDM) [1, 2, 3]. This complication develops in less than half of all diabetic patients [4, 5]and is classically preceded by a period of microalbuminuria, i.e., a slight elevation in urinary albumin excretion rate (UAER) [2, 6].…”

Section: Introductionmentioning

confidence: 99%

Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism and Diabetic Albuminuria in Patients with NIDDM Followed Up for 9 Years

Xiao-hong¹,

Rantalaiho

Wirta

et al. 1998

Nephron

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Nephropathy is a major cause of premature morbidity and mortality in patients with non-insulin-dependent diabetes mellitus (NIDDM). The insertion/deletion (I/D) polymorphism of angiotensin-converting enzyme (ACE) is a genetic determinant of plasma ACE levels. Recent studies have found I/D polymorphism of the ACE gene to be associated with nephropathy in NIDDM. This association has not been evaluated in prospective studies. We, therefore, studied the relationship between ACE gene I/D polymorphism and diabetic albuminuria and glomerular filtration rate (GFR) in 83 NIDDM patients followed up for 9 years. At baseline, 29% (24 of 83) of the diabetic patients had an increased (>30 mg/24 h) urinary albumin excretion rate (UAER) and the prevalence of albuminuria at the 9-year examination was 35% (29 of 83). During the follow-up period, systolic blood pressure (p = 0.044), prevalence of hypertension (p < 0.01), and fasting blood glucose levels (p < 0.01) increased, while high-density lipoprotein cholesterol (p < 0.01) decreased. The declines of GFR during the follow-up period were 8.5, 14.1, and 16.3% within genotype groups of II, ID, and DD, respectively (p values for decreases: NS for II, <0.001 for ID, and <0.001 for DD). Patients with the DD genotype tended to have a steeper decrease of GFR, but the change was not statistically significant between the genotype groups. The increases of UAER during the follow-up period were 35.1, 8.3, and 122.4% within genotype groups of II, ID, and DD, respectively, but p values for all increases were not significant. Parallel to GFR, patients with the DD genotype tended to have a steeper increase of UAER, but the change was not statistically significant between the genotype groups. There were no differences in the ACE genotype distribution and allele frequencies between the patients with or without albuminuria either at follow-up or in cross-sectional settings. In conclusion, this 9-year follow-up study does not support the hypothesis that the ACE I/D polymorphism is a major genetic marker of diabetic nephropathy in NIDDM patients.

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Prospective Study of Microalbuminuria as Predictor of Mortality in NIDDM

Cited by 289 publications

References 27 publications

Middle Cerebral Artery Stenosis in Type II Diabetic Chinese Patients Is Associated with Conventional Risk Factors but Not with Polymorphisms of the Renin-Angiotensin System Genes

Middle Cerebral Artery Stenosis in Type II Diabetic Chinese Patients Is Associated with Conventional Risk Factors but Not with Polymorphisms of the Renin-Angiotensin System Genes

Cardiovascular risk assessment in patients with diabetes

Angiotensin-Converting Enzyme Insertion/Deletion Polymorphism and Diabetic Albuminuria in Patients with NIDDM Followed Up for 9 Years

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