Abstract
To investigate the relationship between micro- and macroangiopathy (MA) in diabetic subjects, prevalence, and clinical characteristics of cardiac, cerebral, and peripheral vascular disease were studied in 842 subjects with NIDDM. Stages of nephropathy were defined as normoalbuminuria (N=471), microalbuminuria (N=250), overt proteinuria (N=75), and chronic renal failure (s-Cr≥2mg-dl, N=46). Prevalence of ischemic heart disease (IHD), cerebral infarction (CI), and arteriosclerosis obliterans (ASO) in the 4 groups showed a significant correlation with the degree of nephropathy, and occurred most frequently in subjects with renal failure. Aging, duration of diabetes, hypertension, and reduced concentrations of HDL-C, which were common risk factors for these MA patients, were also related to the stages of nephropathy. In addition, multivariate analysis indicated that the urinary albumin excretion rate itself could be an independent risk factor for MA, especially IHD and ASO. The mortality rate of subjects with renal failure surpassed that of these with normoalbuminuria by about 15-fold because of renal dysfunction and/or complications of MA. These results suggest that diabetic nephropathy is closely correlated with MA of the heart, brain, and lower extremities. Glycemic control, other means of risk factor management, and evaluation of systemic MA using a noninvasive approach is important for subjects with nephropathy, especially end-stage renal disease, to improve life prognosis.
