HIGH PREVALENCE OF RISK-FACTORS FOR CARDIOVASCULAR-DISEASE IN PARENTSOF IDDM PATIENTS WITH ALBUMINURIA

Life expectancy is shorter in the subset of insulin-dependent diabetic (IDDM) patients who are susceptible to kidney disease. Familial facto rs may be important. In this study the prevalence of cardiovascular di sease mortality and morbidity and of risk factors for cardiovascular d isease was compared in the parents of 31 IDDM patients with elevated a lbumin excretion rate (AER > 45 mu g/min; group A) with that of parent s of 31 insulin-dependent diabetic patients with normoalbuminuria (AER < 20 mu g/min; group B). The two diabetic patient groups were matched for age and duration of disease. Information on deceased parents was obtained from death certificates and clinical records and morbidity fo r cardiovascular disease was ascertained using the World Health Organi zation questionnaire and Minnesota coded ECG. Hyperlipidaemia was defi ned as serum cholesterol higher than 6 mmol/l and/or plasma triglyceri des higher than 2.3 mmol/l and/or lipid lowering therapy; arterial hyp ertension as systolic blood pressure higher than 140 mmHg and/or diast olic blood pressure higher than 90 mmHg and/or antihypertensive treatm ent. The percentage of dead parents was similar in the two groups (26 vs 20 % for parents of group A vs group B, respectively), but the pare nts of the diabetic patients with elevated AER had died at a younger a ge (58 +/- 10 vs 70 +/- 14 years; p < 0.05). Parents of diabetic patie nts with nephropathy had a more than three times greater frequency of combined mortality and morbidity for cardiovascular disease than that of the parents of diabetic patients without nephropathy (26 vs 8 %; od ds ratio 3.96, 95 % CI 1.3 to 12.2; p < 0.02), Living parents of group A had a higher prevalence of arterial hypertension (42 vs 14 % p < 0. 01) and hyperlipidaemia (49 vs 26 % p < 0.05) as well as higher levels of lipoprotein (a) [median (range) 27.2 (1-107) vs 15.6 (0.2-98) mg/d l; p < 0.05]. They also had reduced insulin sensitivity [insulin toler ance test: median (range) K-itt index: 3.7 (0.7-6.2) vs 4.8 (0.7-6.7)% per min; p < 0.05]. In the families of IDDM patients with elevated AE R there was a higher frequency of risk factors for cardiovascular dise ase as well as a predisposition to cardiovascular disease events. This may help explain, in part, the high prevalence of cardiovascular dise ase mortality and morbidity in those IDDM patients who develop nephrop athy.