Profile Of Cardiovascular Disease Risk Factors In Normoalbuminuric Nigerian Diabetic Patients.

摘要

BackgroundNephropathy in patients with Diabetes Mellitus is usually progressive, commencing with microalbuminuria and progressing to macroalbuminuria with subsequent development of progressive reduction of glomerular filtration rate. The development of microalbuminuria also substantially increases the risk of cardiovascular morbidity and mortality in the diabetic patients. Recent studies have indicated that substantial cardiovascular risk may exist in patients having proteinuria in the range currently considered to be normal. This risk appears to increase as the level of albuminuria increases in this setting. However, racial and genetic influences on these observations are not known.MethodsThis cross-sectional study, describes the profile of cardiovascular risk factors in 150 normoalbuminuric African diabetic patients with regular clinic attendance at the diabetic clinic of a Teaching Hospital in Lagos, Nigeria. ResultsOne hundred and thirty (86.67%) of the 150 studied subjects had one or more cardiovascular risk factors that did not correlate with the degree of albumin excretion. 50% of the studied subjects were hypertensive, 37.3% were obese, hypercholesterolaemia occurred in 13.3%, elevated LDL in 20% and low HDL in 35.3% of the subjects. Mean duration of diabetes was 6.8yrs.ConclusionsIt was concluded that there is a high background prevalence of Cardiovascular Disease risk factors in these normoalbuminuric Diabetic subjects with short duration of diabetes. This finding is a reflection of the huge Cardiovascular Disease burden in this population of patients. Background Diabetes Mellitus is an important cardiovascular disease risk factor and various studies have shown an increased prevalence of cardiovascular diseases such as coronary artery disease, stroke, peripheral vascular disease and congestive cardiac failure in diabetic patients.[1,2,3] Apart from cardiovascular diseases, diabetic patients also have a substantial risk of developing Chronic Kidney Disease (CKD). [4,5] Reports from renal registries of many developed countries have indicated Diabetic Nephropathy as the most common cause of End Stage Renal Disease in these countries, [6,7] and the trend is evolving in many developing countries in view of the world wide growing prevalence of diabetes mellitus. [8,9] The evolution of CKD in many diabetic subjects develops from a stage of microalbuminuria defined as Albumin Creatinine Ratio (ACR) between 30 to 300mg/g, to the stage of macroalbuminuria (ACR > 300mg/24hr) with development of hypertension and progressive decline in glomerular filtration rate. [5] Most studies on Cardiovascular Diseases in Diabetic patients focused on the diabetics as a group without stratification in respect of presence or absence of nephropathy, making estimation of the contribution of nephropathy to the estimated Cardiovascular Disease burden in these studies difficult .[2] Microalbuminuria apart from being an important predictor of progression of nephropathy in diabetic patients, has also been noted to be a good marker of generalized endothelial dysfunction both in diabetic and non diabetic nephropathies. [10,11] The development of microalbuminuria substantially increases the risk of cardiovascular morbidity and mortality in diabetic as well as non diabetic patients. Recent studies have indicated that substantial cardiovascular risk may exist in patients having proteinuria in the range currently considered to be normal. [12,13,14] This risk appears to increase as the level of albuminuria increases in this setting.[14] However, most of the studies were done in the developed countries and little is known about the pattern of cardiovascular risk factors in normoalbuminuric diabetic subjects in developing countries. Hence the effect of racial and genetic influences on risk factors for diabetic nephropathy in the developing regions is largely unknown.This cross-sectional study, describes the profile of cardiovascular risk factors in normoalbumi