Proteinuria is an independent risk factor for ischemic stroke in non-insulin-dependent diabetes mellitus

Background and Purpose-Proteinuria is an independent risk factor for cardio vascular disease in patients with NIDDM. The aim of this study was to asses s the relationship between proteinuria and ischemic stroke in subjects with NIDDM, and to determine whether proteinuria is an independent risk factor for stroke. Methods-We performed a case-control study of 59 diabetic patients with firs t-ever ischemic stroke due to thrombotic arterial occlusion, who were consi dered cases, and 180 diabetic patients without stroke, matched by gender, a ge, and diabetes duration, as a control group. WHO criteria for verified de finite or possible stroke were used to ascertain the diagnosis of stroke. F or the purpose of this study proteinuria was defined as a 24-hour urinary p rotein excretion rate of greater than or equal to 20 and <200 mu g/min. Ris k factors included were smoking, blood pressure, body mass index, serum tot al cholesterol, hyperglycemia, and proteinuria, Results-Subjects with stroke had higher proteinuria proportion and systolic and diastolic blood pressures. Both frequency of antihypertensive treatmen t and antihypertensive drugs used were similar among subjects with and with out stroke. In multivariate logistic regression analysis, the ORs and 95% C Is for the variables identified as risk factors for stroke were as follows: systolic pressure (OR 3.10; 95% CI3.01 to 4.21; P=0.03); diastolic pressur e (OR 3.30; 95% CI 1.04 to 4.48; P<0.0001); fasting glucose greater than or equal to 11.1 mmol (OR 1.82; 905% CI 1.4 to 3.8; P=0.04), HbAlc greater th an or equal to 9.5% (OR 1.7; 95% CI 1.3 to 5.1; P<0.01), and proteinuria (O R 3.23; 95% CI 1.06 to 4.36; P<0.0001). Conclusions-Our case-control study gives evidence that proteinuria is an in dependent risk factor for ischemic stroke in patients with NIDDM.