MA is a marker of greatly increased cardiovascular morbidity and mortality in T2DM patients.
Objective: To perform a prospective study of normoalbuminuric T2DM patients, analysing the association between CVRF at baseline and the development of MA at follow-up.
Materials and methods: The prospective observational study was performed at Montes de Barbanza public health center, a specialized secondary referral center, which provides services to the 31 urban district of Madrid, Spain, and consisted in 348 T2DM patients. The inclusion criterion at baseline in 2002 was normoalbuminuria (urine albumin <30 mg/24 h.), and the exclusion criteria were previously diagnosed micro or macroalbuminuria or nephropathy. The clinical end-point was MA (urine albumin 30300 mg/24 h.) at follow-up in 2005. The variables at baseline in 2002 were age, gender, onset-age of T2DM, HbA1C, systolic (SBP) and diastolic blood pressure (DBP), total cholesterol (TCh), HDL-Ch, LDL-Ch, triglycerides (TGs), BMI and smoking; and were obtained from our records. Diagnosis of MA was made by two consecutive quantitative test of urine collected over 24 h. Comparison of mean levels were performed with the Students t test for unpaired samples, and proportions with the chi-square test. Logistic regression analyses were performed with MA as a dependent variable, and age, gender, diabetes duration, and other CVRF as independent variables. An odds ratio (OR) >1.0 signifying a positive association, and P<0.05 was considered significant (SPSS, v. 13.0).
Results: Compared to those who still had normoalbuminuria at follow-up, the ones progressing to MA were males (P=0.000), and more likely to have a higher SBP (P=0.001) and TGs (P=0.005), and a lower HDL-Ch (P=0.002). The principal independent CVRF at baseline for the development of MA at follow-up were male gender (OR:3.36; P=0.000), elevated TGs (OR:2.17; P=0.005) and increased SBP levels (OR:1.03; P=0.001).
Conclusions: Male gender, elevated TGs and increased SBP, were independent CVRF for the development of MA in T2DM patients of the population studied. Other CVRF, as decreased HDL-Ch, was associated to MA in T2DM patients