Ateroscleroza carotidiana si relatia cu micro-Albuminuria

in DZ de tip 2

Andritoiu AlexandruSp. Militar Craiova

Relatia DZ-CbVDRelatia DZ-CbVD

CIMT in DZ

CIMTCIMT

• Masuratori manuale• Masuratori automate

VN <0.9 mm

CIMT

CIMT –Marker de risc C-VCIMT –Marker de risc C-V

• Scorul de risc (Framingham, SCORE)

• Boala coronariana ischemica• Sdr. metabolic• Arteriopatia obliteranta• Disfunctia endoteliala (%FMD)• Markerii de inflamatie (hs CRP)

• Studiul ARIC • Studiul Rotterdam • Cardiovascular

Health Study

Carotid Intima-Media Thickness in Patients With Type 2 DiabetesCarotid Intima-Media Thickness in Patients With Type 2 DiabetesThe significance of microalbuminuria and different risk factors for The significance of microalbuminuria and different risk factors for

atherosclerosisatherosclerosis

Maria Matsagoura, Emanouil Andreadis, Emanouil J. Diamantopoulos, Charalambos Vassilopoulos, Nicholas Tentolouris, Nicholas Katsilambros

The lack of association between microalbuminuria and the IMT/ICA valueThe lack of association between microalbuminuria and the IMT/ICA value is explained by the fact that ICAs at the bifurcation are more sensitive to local atherosclerosis and do not necessarily reflect the status of the arterial tree.

Multivariate analysis, after adjustment for a number of confounding factors, such as age, sex, blood pressure, BMI, waist-to-hip ratio, duration of diabetes, HbA1c, age, sex, blood pressure, BMI, waist-to-hip ratio, duration of diabetes, HbA1c, type of antidiabetic treatment, smoking status, plasma lipids, and the use of ACE type of antidiabetic treatment, smoking status, plasma lipids, and the use of ACE inhibitors and statins,inhibitors and statins, demonstrated that only the presence and degree of microalbuminuria were independently associated with IMT/CCA.

Diabetes Care – Oct. 2003: vol. 26 - no. 10: 2966

Stroke 1997; 28: 1710-1716

Microalbuminuria and Carotid Artery Intima-Media Thickness in Nondiabetic and NIDDM Subjects

The Insulin Resistance Atherosclerosis Study (IRAS)

Conclusions: Microalbuminuria was associated with increased CCA IMT. This relationship was only partly mediated by hypertension. Thus, microalbuminuria is related to atherosclerosis at an early stage of the disease process.

We found IMT to be higher in type 2 diabetic patients compared with the controls, and the presence of albuminuria had no further effect on IMT in these patients

Exista o relatie Exista o relatie ATS CAR-microAlbuminurie la ATS CAR-microAlbuminurie la

pacientii diabeticipacientii diabetici???????????????????????????

Lot de studiuLot de studiu

• N = 64 pts DZ tip 2

• Lot ALot A (N = 22) - microAlb <10 microgr/dL

• Lot BLot B (N = 42) - microAlb>10 microgr/dL

Metoda de studiuMetoda de studiu

• US-CAR

• CIMT (masurare manuala)

• Scor placi CAR

• frecv. placi CAR

• Dozare microAlb (urine sample)

• Analiza statistica (MedCalc)

Loturile de studiuLoturile de studiu

Parametru Parametru Lot ALot A Lot BLot BVarsta (ani) 61.5+/-5.6 61.24+/-9.4 NS

Vechime DZ(ani) 4.72+/-3.66 6.38+/-4.7 NS

Glicemie 188+/-96 180+/-63 NS

mAlb (micgr/dL) 7.06+/-1.7 23.15+/-19.8 p=0.01

HbA1c (%) 8.35+/-2.67 8.02+/-2.3 NS

CIMT (mm) 0.71+/-0.29 0.75+/-0.26 NS

Scor placi 3.96+/-4.72 4.86+/-4.56 NS

Frecv. placi 63.64% 62% NS

CIMT- analiza multivariata

ParametruParametru r =r = p =p = IC 95%IC 95%

Vechime DZ 0.038 0.8 (0.31-0.38)

Glicemie 0.19 0.29 (-0.17-0.50)

HbA1c 0.37 0.03 (0.03-0.64)

Mico-Alb -0.06 0.74 (0.40-0.29)

Scor placi 0.55 0.0009 (0.25-0.75)

Plaques score-analiza Plaques score-analiza multivariatamultivariata

Parametru Parametru r =r = p =p = IC 95%IC 95%

Vechime DZ 0.24 0.19 (-0.12-0.56)

Glicemie 0.16 0.38 (-0.20-0.48)

HbA1c 0.27 0.14 (-0.08-0.56)

Micro-Alb 0.14 0.42 (-0.21-0.47)

Varsa pts (ani)Varsa pts (ani) 0.320.32 0.070.07 (-0.03-0.60)(-0.03-0.60)

Relatia MicroAlb-ATS Relatia MicroAlb-ATS CARCAR

Scorul placilor CAR

4,86 3,96

mAlb <10 mAlb>10

CIMT (mm)

0,80+/-0,3

0,72+/-0,3

mAlb <10 mAlb>10

p=0.6 (NS)

p=0.49 (NS)

Frecventa placilor CAR

62%63,65%

mAlb<10 mAlb>10

p=0.8 (NS)

Scorul placilor CAR

5,88

2,34

HbA1c<6,5% HbA1c>6,5%

p=0.03

Relatia HbA1c-ATS CARRelatia HbA1c-ATS CAR

CIMT (mm)

0,89+/-0,3

0,61+/-0,2

HbA1c<6,5% HbA1c>6,5%

Frecventa placilor CAR75%

41,66%

HbA1c<6,5% HbA1c>6,5%

p=0.007

p=0.01

ConcluziiConcluzii

• ATS-CAR este un fenomen vascular frecvent la diabetici• Prezenta sa nu se coreleaza cu vechimea DZ-2 sau

nivelul glicemiei a jeun, • CIMT se coreleaza slab cu concentratia HbA1c• Scorul placilor se coreleaza doar cu varsta inaintata a

pacientilor si CIMT• Relatia ATS-CAR si microAlb este complexa si

multifactoriala • Alte metode de evaluare sunt necesare (randomizare

Mendeliana?) pentru a preciza rolul microAlb in aparitia si progresia ATS

Journal of Human Hypertension (2000) 14, 831-835

Dissociation between microalbuminuria and common carotid thickness in essential hypertensive men

R Pedrinelli, G Dell'Omo, G Penno, S Bandinelli, D Giannini, A Balbarini, M Mariani

Conclusion: This cross-sectional study in hypertensive subjects free of cardiovascular disease has shown a dissociation between microalbuminuria and CCA IMT, a surrogate measure of subclinical atherosclerosis, and a parameter linearly related to cardiovascular events.

The data do not support the theory of microalbuminuria as a surrogate measure of subclinical atherosclerosis, while confirming the importance of systolic BP levels as an independent correlate of increased albuminuria in essential hypertension.