Microalbuminuria, alteraciones lipídicas y cardiopatía coronaria en diabéticos no insulino dependientes / Microalbuminuria, serum lipid abnormalities and coronary heart disease in non-insulin-dependent diabetics

RESUMO

Background: Microalbuminuria could be a possible coronary risk factor. Aim: To study the association between microalbuminuria, serum lipid levels and coronary heart disease in non-insulin-dependent diabetics. Patients and methods: We studied 104 non-insulin-dependent diabetics, who were separated in four groups according to the presence of microalbuminuria, defined as a 24 h albumin excretion of 30 mg/24 h or more and according the history of coronary artery disease. Total, HDL and LDL cholesterol, triglycerides, alpha, beta, prebeta lipoproteins, lipoprotein (a), apoproteins A and B were measured in all. Results: Twenty patients with and 32 without coronary artery disease had normal albumin excretion and the same number of patients had a urinary albumin over 30 mg/24 h. All four groups were comparable in terms of metabolic control, nutritional status, blood pressure and creatinine levels. Patients with coronary artery disease had higher urinary albumin excretion than patients without the disease (91 (32-173) and 34 (5-97) mg/24 h respectively p <0,01). Patients with coronary artery disease and microalbuminuria had higher triglycerides, beta pre beta lipoproteins, Apo B, Lp(a) and lower Apo B and alpha lipoproteins. This group also had a higher frequency of abnormal pre beta and alpha lipoprotein levels, when compared with coronary patients with normal albumin excretion. In coronary patients there was a positive association between urinary albumin levels and triglycerides (r= 0.24), pre beta lipoproteins (r= 0.27) and Apo B (r= 0.3); there was also a negative association with HDL cholesterol (r= 0.25) and alpha lipoproteins (r= -0,41). Conclusions: In this group of non-insulin-dependent diabetics, an association among microalbuminuria, abnormal serum lipid levels and coronary artery disease was detected