RELATIONSHIP BETWEEN LIPOPROTEIN PROFILE AND URINARY ALBUMIN EXCRETION IN TYPE-II DIABETIC-PATIENTS WITH STABLE METABOLIC CONTROL

OBJECTIVE - To assess lipids and lipoprotein composition and the relat ionship between lipoprotein abnormalities and urinary albumin excretio n (UAE) in select type II diabetic patients with stable metabolic cont rol. RESEARCH DESIGN AND METHODS - Fifty-five type II diabetic patient s and 55 healthy control subjects-both with a body mass index <30 kg/m (2) were studied. Patients were classified according to their level of UAE as normoalbuminuric (n = 37), microalbuminuric (n = 11), and macr oalbuminuric (n = 7). In all cases, serum creatinine and albumin conce ntrations were in the normal range. RESULTS - Normoalbuminuric patient s showed increased triglyceride (TG) contents in intermediate-density lipoprotein (IDL) (P < 0.01), low-density lipoprotein (LDL) (P < 0.001 ), and high-density lipoprotein (HDL) (P < 0.001) compared with contro l subjects. Lipoprotein concentration in microalbuminuric patients did not differ from that of normoalbuminuric patients. On the other hand, patients with macroalbuminuria showed a significant increase in IDL c holesterol (P < 0.01) and IDL (P < 0.01), LDL (P < 0.05), and HDL TGs (P < 0.01) compared with the other groups. Diabetic patients with neph ropathy, both microalbuminuric and macroalbuminuric, tended to have hi gher mean lipoprotein(a) (Lp[a]) concentrations than normoalbuminuric patients and control subjects. A strongly positive correlation was obs erved between UAE and serum TGs (r = 0.56) and very-low-density lipopr otein (r = 0.55), IDL (r = 0.52), LDL (r = 0.54), and HDL TGs (r = 0.5 2). CONCLUSIONS - Lipoprotein alterations observed in diabetic patient s, specifically IDL abnormalities and a tendency toward high Lp(a) lev els, which are more marked in those with increased UAE, may contribute to the excess of cardiovascular disease in type II diabetic patients, particularly those with nephropathy.