RISK FACTOR-ANALYSES FOR MACROVASCULAR COMPLICATION IN NONOBESE NIDDM- PATIENTS MULTICLINICAL STUDY FOR DIABETIC MACROANGIOPATHY (MSDM)

To examine the characteristic features of risk factors for macroangiop athy (MA) in nonobese Japanese NIDDM patients, 899 NIDDM patients with and without MA were registered from 40 facilities. Of these, 386 subj ects were identified as having any form of MA (total MA); these includ ed 211 with ischemic heart disease (IHD), 163 with cerebrovascular dis ease (CVD), and 77 with peripheral vascular disease (PVD). Univariate analyses revealed the following common risk factors for total MA, IHD, CVD, and PVD: age, hypertension, systolic blood pressure (sBP) or dia stolic blood pressure (dBP), duration of diabetes, diabetic microangio pathy (retinopathy, nephropathy, and neuropathy), low HDL cholesterol level, and higher LDL cholesterol/HDL cholesterol ratio. Additional si gnificant risk factors for specific conditions were also identified, r espectively, as male sex for total MA, IHD, and PVD, smoking for inn a nd PVD, and high fasting plasma glucose level for total MA and CVD. Wi th stepwise multivariate logistic regression analysis, older age, dura tion of diabetes, smoking, and low LDL cholesterol/HDL cholesterol rat io were identified as significant and independent risk factors for tot al MA, IHD, CVD, and PVD. Other risk factors identified were high dBP for IHD, CVD, and PVD, high sBP for total MA, and low BMI for PVD. The se results clearly demonstrated that duration of diabetes, smoking, hy pertension, and dyslipidemia are major risk factors for MA in NIDDM pa tients. Since the mean BMI was similar for both groups (similar to 23 kg/m(2)) and there were no significant differences in immnnoreactive i nsulin levels before and after 75-g oral glucose challenge testing, ob esity and hyperinsulinism at the time of the analyses were not conside red to play an important role for the pathogenesis of MA in Japanese N IDDM patients. By using the chi(2) test, cutoff points were determined for six of the most commonly measured risk factors. The cutoff point was the level beyond which a significantly higher prevalence of MA occ urred. The cutoff points (rounded slightly upward in some cases) for f asting plasma glucose, sBP, dBP, serum total cholesterol level, serum triglyceride level, and BMI were 140 mg/dl, 140 mmHg, 80 mmHg, 180 mg/ dl, 120 mg/dl, and 23 kg/m(2), respectively. When these cutoff points were used as control criteria, the prevalence of MA was significantly lower in subjects whose risk factor measurements remained under the pr oposed control criteria for four or more of the six variables. In conc lusion, in nonobese NIDDM patients, age, hypertension, and dyslipidemi a were found to be risk factors for MA. Duration of diabetes was also demonstrated as an independent risk factor, indicating the close assoc iation of deranged glucose metabolism with the pathogenesis of MA in N IDDM patients. It seems to be crucial to control these risk factors fo r the prevention of MA in NIDDM patients.