ABSTRACT
Microalbuminuria [MA] is indicative of generalized vascular disease and is related to carotid intima-media thickness [IMT] -which is a marker of macrovascular disease[1]. In this study, we investigated the role of high plasma level of von Mile brand factor [vWJ], as a marker of endothelial dysfunction, in predicting macrovascular disease in type 2 diabetic patients with microalbuminuria. The study group consisted of 30 non- smoking, normotensive type 2 diabetic patients with normal renal function. They were all recruited from the medical outpatient clinic at Kasr El Aini hospital, Cairo University. They were divided into two groups: Group [1]: included 17 [10 male and 7 female] patients with MA[mean age of 56 +/- 8.4, mean diabetes duration 11.6 +/- 3.7 years, mean body mass index " BMI" 30.2 +/- 5.4kg/m[2]], Group[2]: included 13 [5 male and 8 female] patients without MA [mean age 55.5 +/- 8.6years, mean diabetes duration 5.7 +/- 2.6years, mean BMI 29.6 +/- 6.7 kg/m[2]]. Urinary albumin excretion was assessed both qualitatively and quantitatively .Plasma level of vWf was expressed in relative percent [%] as compared to pooled normal plasma. Carotid IMT was evaluated using high resolution B-mode Ultrasonography. Ten age, sex and weight matched normal subjects were included in the study as a control group. Plasma level of vWf was significantly elevated in the study group compared to the control one [182.2 +/- 22.4 vs 85.5 +/- 23.7%, P=0.0001]. Carotid IMT was also significantly higher in type 2 diabetic patients compared to the control group [0.724 +/- 0.421 vs 0.40 +/- 0.06 mm, P=0.0001]. Among the study group, plasma level of vWf was higher in group [1] compared to group [2] [198.5 +/- 23.5 vs 106.0 +/- 20.0%, p=0.001] .Also, carotid IMT was higher in group [1] compared to group [2][0.975 +/- 0.338 vs 0.580 +/- 0.103 mm, p=0.001] .In group [1], there was a positive correlation between plasma level of vWf and fasting blood glucose [r=0.47, p=0.01], post prandial blood glucose [r=0.51, p= 0.01], glycated haemoglobin [r=0.49, p=0.01] .total cholesterol [r= 0.42, p=0.04], triglycerides [r=0.41,p=0.04], MA[r=0.52,p=0.001] and carotid IMT [r=0.61, p=0.0001]. Patients with retinopathy [18 patients] had a significantly higher age, duration of the disease, fasting and post prandial blood glucose, microalbuminuria, intima media thickness [0.8 +/- 0.5 vs 0.2 +/- 0.3mm, P=0.01] and von Willebrand factor [199.8 +/- 2 3.7vs 105.8 +/- 20.65, P=0.04], and a significant lower level of high density lipoprotein[37.055 + 8.814 vs 43.91 +/- 8.106 mg/dl, p= .039], compared to the diabetic group with normal fundi [12 patients].Multiple regression analysis showed that the determinants of carotid IMT in the study group were disease duration [p=0.01], triglycerides [p=0.01], MA[P=0.001], plasma level of vWf [P=0.001] and retinopathy [p=0.01]. The results of this study indicate that among type 2 diabetic patients with MA, those with higher plasma levels of vWf have greater risk of macrovascular disease. Analysis of the results also proves that plasma level of vWf is an independent risk factor for macrovascular disease in type 2 diabetic patients. Measurement of plasma level of vWf would be helpful in assessing the risk of macrovascular disease in those patients