DYSLIPIDEMIA AND CARDIOVASCULAR-DISEASE IN NON-INSULIN-DEPENDENT DIABETIC-PATIENTS WITH AND WITHOUT DIABETIC NEPHROPATHY

In 370 non-insulin-dependent diabetic (NIDDM) patients less than 66 ye ars of age, we found the prevalence of albuminuria (> 300 mg 24 h(-1)) to be 13.8%. Males had a higher prevalence than females (19 vs. 5%). A kidney biopsy was performed in 35 patients. The biopsy revealed diab etic glomerulosclerosis in 77% of the cases and a variety of nondiabet ic glomerulopathies in the remaining 23%. Fifty-six per cent of the pa tients with diabetic glomerulosclerosis had diabetic retinopathy, wher eas none of the patients with non-diabetic glomerulopathies had signs of retinopathy. The presence of diabetic retinopathy strongly suggests that diabetic glomerulosclerosis is the cause of albuminuria. During a 5-year (range 1-7 years) prospective study, the course of kidney fun ction was followed in 26 NIDDM patients with diabetic glomeruloscleros is. The glomerular filtration rate declined, and elevated systolic blo od pressure was positively correlated to the rate of decline. The freq uency of diabetic complications increased with increasing levels of ur inary albumin excretion. In a cross-sectional study of 549 NIDDM patie nts, the prevalence of proliferative retinopathy was 2, 5 and 12%, the prevalence of hypertension 46, 68 ad 85%, and the prevalence of ischa emic heart disease 22, 26 and 46% in normo-, micro-, and macroalbuminu ria, respectively. The mortality from cardiovascular disease is increa sed ninefold in NIDDM patients with macroalbuminuria compared to the n on-diabetic background population. The presence of the well-establishe d risk factors cannot account for this finding alone. Apolipoprotein(a ) [apo(a)] has been shown to be an independent risk marker for prematu re ischaemic heart disease in subjects with and without familial hyper cholesterolaemia. We assessed the possible contribution of dyslipidaem ia in general and elevated apo(a), in particular, in NIDDM patients wi th normoalbuminuria (n = 37), microalbuminuria (n = 37) and macroalbum inuria (n = 37) compared to healthy subjects (n = 37). There was no si gnificant difference between the level of apo(a) in the four groups. I n summary, albuminuria is present in approximately 15% of patients wit h NIDDM. In three out of four patients, the cause of albuminuria is di abetic glomerulosclerosis. The frequency of late diabetic complication s rises with increasing urinary albumin excretion. NIDDM patients with increased urinary albumin excretion (prevalence 40%) frequently suffe r from dyslipidaemia and cardiovascular disease. However, our study re vealed no significant elevation in serum concentration of apo(a) in pa tients with diabetic nephropathy, but numbers were small.