The emerging role of ACE inhibitors in diabetes: From theory to therapeutic management

Abstract

M icroalbuminuria was identified more than a decade ago as predicting diabetic nephropathy both in patients with insulin-dependent and non-insulin-dependent diabetes. More surprisingly, however, reports from the early 1980s described an association between microalbuminuria and atherothrombotic vascular disease. ~,2 The figure for this risk differ from between a twofold and an eightfold increase in non-insulindependent patients with microalbuminuria. A more recent study from London, UK, has shown that microalbuminuria is able to predict cardiovascular mortality over a 23-year follow-up in insulin-dependent diabetic patients. 3 These observations are supported by the finding of a substantially increased mortality rate from cardiovascular disease in proteinuric patients with insulin-dependent diabetes, some 8.5 times in excess of nonproteinuric patients. 4 Several studies have now demonstrated an association between microalbuminuria and cardiovascular disease in nondiabetic subjects. We have shown that around 10°/, of the population aged over 40 years have an increase in albumin excretion rate, and these subjects have a substantially increased risk of death, predominantly from cardiovascular disease. 5 Thus, any mechanism invoked to explain the connection between microalbuminuria and cardiovascular disease must be independent of the existence of glucose intolerance.