RENAL AND CARDIOVASCULAR PREDICTORS OF 9-YEAR TOTAL AND SUDDEN CARDIAC MORTALITY IN NON-INSULIN-DEPENDENT DIABETIC SUBJECTS

Background. The objective was to evaluate the impact of urinary albumi n excretion rate (UAER), glomerular filtration rate (GFR) and subclini cal autonomic neuropathy (SANP) on 9-year total (TM) and sudden cardia c mortality (SCM) in recently diagnosed (< 1 year; RD; n = 150) and kn own (mean duration 11 years; KD; n = 146) NIDDM subjects. Methods. The study was prospective and controlled (n = 150). Mortality predictors were analysed by logistic regression analysis. The dependent variables were TM and SCM, the predictors were UAER, GFR, SANP, age, gender, BM I, mean arterial pressure (MAP), fasting serum cholesterol, HDL-choles terol, triglycerides, insulin, haemoglobin Ale, diabetes duration, QTc -interval (ECG), coronary heart disease (CHD), peripheral vascular dis ease (PVD), cerebrovascular disease (CVD), congestive heart failure (C HF), antihypertensive therapy, and smoking habits. Results. CHD predic ted TM and SCM in both RD (P = 0.041 and 0.029) and KD (P = 0.034 and 0.006). PVD predicted TM and SCM in KD only (P = 0.001 and 0.003). CVD predicted TM and SCM in RD only (P = 0.001 and 0.017). In RD male gen der (P = 0.049), fasting serum cholesterol (P = 0.007) and CHF (P = 0. 001) predicted TM and in kDa haemoglobin A1c (P = 0.004), age (P = 0.0 01) and MAP (P = 0.014) predicted TM. Serum triglycerides predicted SC M in both RD and kDa (P = 0.001 and 0.003). SANP predicted TM (P = 0.0 09) and SCM (P = 0.044) in KD only. GFR (inverse value) predicted TM a nd SCM (P = 0.04 and 0.027) in kDa only. The UAER did not predict mort ality in the diabetic subjects. Conclusion. SANP and a slightly reduce d GFR still in the normal range predicted mortality in KD. Microalbumi nuria (30 < UAER < 300 mg/24 h) did not independently predict 9-year m ortality in the NIDDM subjects studied.