Macrovascular and microvascular complications in type 2 diabetes patients

Czech version

Authors: H. Rosolová; B. Petrlová; J. Šimon; P. Šifalda; I. Šípová; F. Šefrna
Authors‘ workplace: II. interní klinika Lékařské fakulty UK a FN Plzeň, přednosta doc. MUDr. Jan Filipovský, CSc.
Published in: Vnitř Lék 2008; 54(3): 229-237
Category: Original Contributions

Overview

The prevalence of chronic vascular complications is higher in patients with type 2 diabetes mellitus (DM2).

The objective of our cross-sectional study was to assess the incidence and types of macrovascular (MVC) and microvascular (mvc) complications and to analyse their relation to the different risk factors and biomarkers in order to improve their prevention.

Set of patients and methodology:
415 patients (219 men and 196 women) with an average age of 66 ± 9 years enrolled in the study. A total of 95 % of patients with DM2 had a history of hypertension, 27 % had MVC (of which 55 % had ischaemic heart disease), and 54 % had mvc (of which 95 % had diabetic nephropathy).

Results:
The patients with vascular complications were significantly older and had a longer history of DM2; they did not differ for their systolic blood pressure, but had a higher pulse pressure and took more antihypertensives. They did not differ for their lipid levels or the respective therapy. Diabetic patients with MVC and mvc had higher insulin resistance, higher plasmatic levels of total homocysteine and a higher incidence of albuminuria or proteinuria. The factors which significantly and independently associated with MVC were male gender, age over 60 years, higher hs-C-reactive protein (hs-CRP) exceeding 1 mg/l, glycaemia over 5.6 mmol/l, lower diastolic blood pressure and lower HDL-cholesterol; mvc associated with higher age over 60 years, a history of DM2 exceeding 8 years, and hs-CRP above 1 mg/l.

Conclusion:
Our results show that patients with DM2 have a high incidence of vascular complications significantly associated with age, DM2 history and higher hs-CRP, irrespective of the other monitored parametres.

Key words:
type 2 diabetes mellitus – cardiovascular diseases – microvascular complications – hs-C-reactive protein

Sources

1. King A, Aubert RE, Herman WH. Global burden of diabetes 1995-2025. Prevalence, numerical estimates and projections. Diabetes Care 1998; 21: 1414-1431.

2. Cífková R. Hypertenze a diabetes mellitus. In: Widimský J et al. Hypertenze. Praha: Triton 2002: 291-301.

3. Kannel WB, McGee DL. Diabetes and cardiovascular disease. JAMA 1979; 241: 1035-2038.

4. Hu G et al. Sex differences in cardiovascular and total mortality among diabetic and non-diabetic individuals with or without history of myocardial infarction. Diabetologia 2005; 48: 856-861.

5. Yusuf S, Hawken H, Ounpuu S et al. Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (The INTERHEART Study): case-control study. Lancet 2004; 364: 937-952.

6. Matthews DR et al. Homeostasis model assessment. Diabetologia 1985; 28: 412-419.

7. Cífková R, Škodová Z. Dlouhodobý trend hlavních kardiovaskulárních rizikových faktorů v české populaci. Čas Lék Čes 2004; 143: 219-226.

8. Facchini FS, Hollenbeck CB, Jeppesen J et al. Insulin resistance and cigarette smoking. Lancet 1992; 339: 1128-1130.

9. Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults. Executive summary of the third report of the National Cholesterol Education Program (NCEP) Expert Panel on Detection, Evaluation, and Treatment of High Blood Cholesterol in Adults (Adult Treatment Panel III). JAMA 2001; 285: 2486-2497.

10. Rosolová H, Petrlová B, Šimon J et al. Association of high sensitivity C-reactive protein with hypertriglyceridemic waist in patients with type 2 diabetes and metabolic syndrome. Med Sci Monit 2008 (sent for publication).

11. Dale AC, Nilsen TI, Vatten L et al. Diabetes mellitus and risk of fatal ischemic heart disease by gender: 18 years follow-up of 74 914 individuals in the HUNT 1 Study. Eur Heart J 2007; 28: 2924-2929.

12. Turner RC, Millns H, Neil HA et al. Risk factors for coronary artery disease in non-insulin dependent diabetes mellitus: United Kingdom prospective diabetes study (UKPDS: 23). BMJ 1998; 316: 823-828.

13. Vaverková H, Soška V, Rosolová H et al. Doporučení pro diagnostiku a léčbu dyslipidémií v dospělosti, vypracované výborem ČSAT. Vnitř Lék 2007; 53: 181-197.

14. Rosolová H, Petrlová B, Šimon J. Závěrečná zpráva výzkumu IGA MZ ČR 8279-3 (2005-2007)

15. Škrha J. Diabetes mellitus 2002 v České republice - Epidemiologická studie. DMEV 2005; 8: 5-12.

16. Grundy SM, Vega GL, Juan Z et al. Effectiveness and tolerability of Simvastatin plus Fenofibrate for combined hyperlipidemia (The SAFARI Trial). Am J Cardiol 2005; 95: 462-468.

17. Denke M, Pearson T, McBride P et al. Ezetimibe added to ongoing statin therapy improves LDL-C goal attainment and lipid profile in patients with diabetes or metabolic syndrome. Diab Vasc Dis Res 2006; 3: 93-102.

18. Farnier R, Freeman MW, Macdonell G et al. Efficacy and safety of the coadministration of ezetimibe eith fenofibrate in patients with mixed dyslipidemic. Europ Heart J 2005; 26: 897-905.

19. Keech AC, Mitchell P, Summanen PA et al. Effect of fenofibrate on the need for laser treatment for diabetic retinopathy (FIELD Study) - randomised controlled trial. Lancet 2007; published on-line on 6 November. DOI:10.1016/S0140-6736(07)61607-9.

20. Souček M, Widimský J sr, Lánská I. Control of hypertension in patients with hypertension, diabetes, and impaired fasting glucose by Czech primary care physicians. Kidney Blood Press Res 2006; 29: 366-372.

21. Rosolová H, Šimon J, Šefrna F. Impact of cardiovascular risk factors on morbidity and mortality in Czech middle-aged men - Pilsen Longitudinal Study. Cardiology 1994; 85: 61-68.

22. Ridker PM, Buring JE, Cook NR et al. C-reactive protein, the metabolic syndrome, and risk of incident cardiovascular events an 8-year follow-up of 14,719 initially healthy American women. Circulation 2003; 107: 391-397.

23. Ridker PM, Rifai N, Pfeffer MA et al. The Cholesterol and Recurrent Events (CARE) Investigators: Inflammation, pravastatin, and the risk of coronary events after myocardial infarction in patients with average cholesterol levels. Circulation 1998; 98: 839-844.

24. Ridker P, Cushman M, Stampfer M et al. Inflammation, aspirin, and the risk of cardiovascular disease in apparently healthy men. N Engl J Med 1997; 336: 973-979.

25. United Kingdom Prospective Diabetes Study Group: Intensive blood glucose control with sulfonylureas or insulin compared with conventional treatment and risk of complications in patients with type 2 diabetes (UKPDS 33). Lancet 1998; 352: 837-853.