CARDIOVASCULAR MORBIDITY IN PROTEINURIC SOUTH INDIAN NIDDM PATIENTS

Proteinuria is a well known risk factor for cardiovascular morbidity. There has been no report on cardiovascular morbidity in Indian NIDDM p atients with proteinuria. Hence this study has been undertaken to esti mate the prevalence of cardiovascular diseases (CVD) in South Indian N IDDM with proteinuria, We studied two groups of NIDDM patients with di abetes for greater than or equal to 5 years: group PR with persistent proteinuria of > 500 mg/day (n = 297) and group NPR with normoalbuminu ria (albuminuria less than or equal to 30 mu g/mg creatinine) (n = 296 ), who reported for review during the study period. They were matched for age, duration of diabetes and BMI. The prevalence of cardiovascula r diseases, namely myocardial infarction, the presence of ischaemic he art disease and the history of coronary bypass surgery were compared i n the two groups. The prevalence of hypertension was higher among the PR than the NPR patients (56.5 vs 24.7%, chi(2) = 61.3, P < 0.001). CV D were detected in 39.2% (n = 116) of the PR and 13.2% (n = 39) of the NPR groups. (chi(2) = 54.85, P < 0.001). The risk was thus three-fold higher in the PR group. Univariate analysis showed that in the protei nuric group, the prevalence of complications was higher in association with hypertension (45.8 vs 30.2%, chi(2) = 6.82, P = 0.009). Multiple logistic regression analysis showed that the factors associated with CVD were proteinuria (odds ratio 5.03), age (OR 1.08) and BMI (OR 1.07 ) while sex, age at onset of diabetes, duration of diabetes, hypertens ion, smoking, HbA(1), serum creatinine, cholesterol and triglycerides did not show independent contribution. The study, highlights the high risk conferred by macroproteinuria in Indian NIDDM patients. This risk is found to be independent of the presence of associated hypertension . (C) 1998 Elsevier Science Ireland Ltd. All rights reserved.