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Renal Function, Albumin-Creatinine Ratio and Pulse Wave Velocity Predict Silent Coronary Artery Disease and Renal Outcome in Type 2 Diabetic and Prediabetic Subjects

Author(s):

Ramiro A. Sanchez*, Maria Josefina Sanchez and Agustin J. Ramirez   Pages 1 - 6 ( 6 )

Abstract:


Introduction: Silent coronary heart disease is frequently undetected in type 2 diabetes mellitus (DM2) and pre diabetes determined by glucose intolerance (GI). Pulse wave velocity (PWV) and albumin-creatinine ratio (ACR) have been considered markers of cardiovascular mortality, coronary heart disease and chronic renal failure.

Aims: To evaluate the incidence of coronary artery disease (CAD) and the relationship between urinary albumin-creatinine ratio, glomerular filtration rate (GFR) and PWV in type 2 DM with silent CAD.

Methods: We analyzed 92 individuals (44 male), 49 (60±7y) type 2 DM non-insulin dependents and 43 prediabetics (43±4y), with Grade I-II hypertension and no symptoms of CAD. All type 2 DM patients were under antidiabetic treatment with an A1C hemoglobin between 5.5 and 6.5%. Every patient underwent a myocardial perfusion SPECT scan. In those subjects with ischemic patterns, a coronary angiography was performed. In addition, a PWV, glomerular filtration rate, and ACR were evaluated. Statistics: mean±SEM, and ANOVA among groups.

Results: 48.59% of DM2 and 25.58% of GI patients had silent coronary artery disease. DM2 and GI patients with CAD had higher ACR and PWV and reduced GFR. DM2 and GI showed a negative relationship between GFR and ACR. Moreover, this relation was also observed in different levels of GFR (>60 ml/min and <60ml.min (p<0.05) in patients with CAD, suggesting a cardio-renal interaction in DM2.

Conclusions: Higher PWV, lower GFR and ACR predict the incidence of CAD in DM2. Dysglycemic individuals also represent a group of higher risk for coronary artery disease with similar predictors showed in DM2. Diabetic and prediabetics, still develop renal microalbuminuria. Thus, PWV seems to represent a reliable marker of renal impairment and coronary artery disease.

Keywords:

Type 2 diabetes, coronary heart disease, pulse wave velocity, renal impairment

Affiliation:

Hypertension and Metabolic Unit, Favaloro Foundation, Buenos Aires,, Mater Dei Hospital, Buenos Aires,, Hypertension and Metabolic Unit, Favaloro Foundation, Buenos Aires



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