Lipids and diabetic nephropathy: hypertension, microalbuminuria and lipids in type 2 diabetic patients

Abstract

Hypertension and microalbuminuria are pre- dictors of cardiovascular mortality in type 2 (non-in- sulin-dependent) diabetes independently of other con- ventional risk factors. The presence of high triglyceride levels with small and/or dense low density lipoprotein par- ticles is associated with cardiovascular disease. The aim of this study was to analyse the plasma lipids, Na+/Li + countertransport (a genetic marker of hypertension) and microalbuminuria in type 2 diabetic patients. Plasma lipids were determined in 15 normotensive normoalbu- minuric (H-M-), 32 hypertensive normoalbuminuric (H + M -) and 22 hypertensive microalbuminuric (H + M +) type 2 diabetic patients and in 20 sex- and age-matched non-diabetic subjects. Plasma cholesterol was signifi- cantly higher in H+M § patients than in controls (226 + 38 vs 192 -t- 38 mg/dl, mean _+ SD). Plasma triglyce- rides were significantly higher in H +M + patients than in either controls or H- M - patients (192 + 117 vs 104 _+ 59 and 115_+ 52 respectively). The Na +/Li + countertrans- port activity in red blood cells was significantly higher in H+M - and H+M + patients than in controls, and in the type 2 diabetic patients it was directly related to plasma triglycerides (r = 0.53, P < 0.0001) and inversely to high density lipoprotein (HDL) cholesterol (r=-0.43, P < 0.0001). Microalbuminuria, hypertension and ele- vated Na +/Li + countertransport activity are thus associ- ated with high triglyceride and low HDL cholesterol levels in type 2 diabetic patients. This atherogenic lipo- protein pattern might at least partially explain the associ- ation of microalbuminuria with cardiovascular disease in type 2 diabetes.