Prevalence Of Cerebrovascular Disease Research Articles

Heritable Connective Tissue Disorders and Stroke

Stroke is a heterogeneous syndrome caused by multiple etiologies. Heritable defects in connective tissue cause a small fraction of ischemic and hemorrhagic stroke. They are the consequence of mutations in genes encoding extracellular matrix constituents such as collagens and proteoglycans. Ehlers–Danlos syndrome, Marfan’s syndrome, osteogenesis imperfecta, and pseudoxantoma elasticum are the most common disorders responsible for cerebrovascular manifestations. Neurofibromatosis and polycystic kidney disease, although not connective tissue disorders, are hereditary diseases with a high prevalence of vascular complications. Ehlers–Danlos syndrome type IV is the most frequent and most life-threatening form due to the presence of intracranial aneurysms, carotid-cavernous fistulas, and arterial dissections. Marfan’s syndrome has a typical phenotype associated with arterial dissections and intracranial aneurysms. Osteogenesis imperfecta, although infrequent, can present with aneurysms, dissections, fistulas, and stenosis of cerebral vessels. Pseudoxanthoma elasticum is commonly associated with occlusive disease of small vessels and other complications such as aneurysms or arteriovenous malformations. Autosomal–dominant polycystic kidney disease is a common cause of multiple intracranial aneurysms. Neurofibromatosis type 1 is characterized by multiple neurofibromas; it is responsible for stenosis or occlusions of intracranial arteries and vascular malformations. These vasculopathies are associated with a relatively high prevalence of cerebrovascular disease; their early recognition should help in the investigation of asymptomatic carriers, and to provide genetic counseling. The growing knowledge of molecular biology could help in the understanding of the underlying mechanism of these complex disorders as well as identify future therapeutic interventions.

Nutrition, démences vasculaires et maladie d’Alzheimer

Approximately 770,000 persons in France suffer from dementia. Alzheimer’s disease is the most frequent cause of dementia, followed by the vascular and mixed forms of dementia. In mixed dementia, the vascular lesions contribute to the severity of the cognitive impairment linked to neurodegenerative lesions. In fact, although the prevalence of cerebrovascular disease and Alzheimer’s disease are both high, some data suggest that their association is not fortuitous. Some vascular risk factors, that also represent risk factors for the development of dementia, are liable to be modified, and especially by nutrition. The question is to what extent nutritional factors may de implicated in the risk of developing dementia, and thus to estimate the possibility of modulating this risk by environmental measures. Cognitively impaired patients lose weight and present many nutritional deficiencies, but transversal studies do not allow to establish a causal link between nutrition and the risk of developing dementia. Longitudinal and cohort studies show an association between diabetes, hyperhomocysteinemia, hypercholesterolemia, low intake in n-3 fatty acids and oxidative stress and the risk of dementia. These nutritional factors contribute to the process of atherosclerosis, but also seem implicated in the physiopathology of neurodegenerative lesions by complex mechanisms. On the whole, few interventional studies have been conducted. Only these studies will help propose specific nutritional recommendations for the prevention of the risk of dementia, and/or to develop a new therapeutic approach. Meanwhile, the priority seems to prevent vascular risk factors, in accordance with the objectives of the Programme National Nutrition et Santé.

Hypertension as a risk factor for glioma? Evidence from a population-based study of comorbidity in glioma patients

Background: Little is known about the aetiology of glioma. Research is often hampered by the low incidence and high mortality of the disease. Concomitant diseases in glioma patients may indicate possible aetiological pathways. We therefore studied comorbidity in glioma patients.Patients and methods: We performed a case-control study using population-based data from the Eindhoven Cancer Registry. We compared prevalences of concomitant diseases in 510 glioma patients with two reference cancer populations from the same registry.Results: Compared with all other cancer patients, a significantly higher prevalence of hypertension was found in glioma patients for age categories 60–74 years [odds ratio (OR) 1.37; 95% confidence interval (CI) 1.02–1.84] and 75+ years (OR 2.37; 95% CI 1.34–4.21). The associaton was most pronounced in elderly men and in astrocytic glioma, with a maximum in age category 75+ years (OR 5.86; 95% CI 2.20–15.7). The prevalence of cerebrovascular disease was higher in glioma patients >45 years old (OR 1.67; 95% CI 1.12–2.47), whereas the prevalence of other cancers was lower (OR 0.64; 95% CI 0.48–0.87). No consistent associations were detected for several other concomitant diseases.Conclusions: Our data suggest an association between hypertension and glioma, although questions remain about causality and the possible mechanisms. We hypothesise that this association is mediated through potentially neurocarcinogenic effects of antihypertensive medication.

The role of cerebrovascular disease in dementia.

Improvements in health care over the last 50 years have lengthened average life expectancy significantly, resulting in considerable growth of the population over 65 years of age. With increased age, however, comes an increased risk for Alzheimer's disease (AD), and the prevalence of AD is predicted to reach epidemic proportions by the later half of the 21st century. The prevalence of cerebrovascular disease also increases with age, and recent evidence suggests that cerebrovascular risk factors such as hypertension and hypercholesterolemia also increase an individual's risk for AD, suggesting a potential interaction between these two very common disorders. The potential impact of cerebrovascular disease on general cognitive health is not yet well understood, but is now being actively explored and clarified. Cerebrovascular disease may manifest itself in many ways, and this review begins by discussing the possible spectrum of brain injury associated with common cerebrovascular risk factors. The prominent role of brain imaging to detect clinically silent cerebrovascular disease is recognized and reviewed. The neuropsychological consequences of cerebrovascular disease across the cognitive spectrum is also reviewed, including potential mechanisms by which cerebrovascular disease may interact with AD to increase the expression or hasten the progression of dementia. Cerebrovascular risk factors, common to the elderly, lead to pernicious brain injury and subtle cognitive impairment that most probably places the individual at greater lifetime risk for dementia. The cause of dementia among individuals with cerebrovascular disease, however, remains AD. Recognition of the potential role of cerebrovascular disease as an independent risk factor for AD offers the possibility of primary prevention through treatment of well-recognized risk factors and deserves further study. In the meantime, clinicians presented with an individual suffering from a slowly progressive dementia and findings of clinically silent cerebrovascular brain injury should recognize the potential role of cerebrovascular disease in the dementia process but not ignore the likely overwhelming effects of AD and treat appropriately.

Prevalence of stroke and transient ischaemic attack in the elderly population of an Italian rural community.

To evaluate the prevalence of stroke and transient ischaemic attack in the elderly population, including the oldest residents, of a rural Italian community. A door-to-door survey was performed between April and October 2001 in 2390 subjects aged 65 years and over. A symptom questionnaire validated by medical records and neurological examination was employed. Complete information was available for 2260 subjects. The overall prevalence of stroke was 8.2% in males and 5.1% in females. In the very elderly, this increased to 10.7% in males and 10% in females and decreased only in males aged 90 years or over. The overall prevalence of transient ischaemic attack was 7% in males and 4.9% in females. This, too, increased with age, reaching 10.2% in males and 7.4% in females and decreased only in subjects of both sexes aged 85 years or over. An actual estimate of the high prevalence of cerebrovascular disease in the elderly population, even in very old subjects, was thus achieved. Appropriate health care services consequently need to be planned.

Síndrome de Down e Moyamoya: estudo através de metanálise

We present a clinic-epidemiological study of two patients and meta-analysis (period 1977-2000 ) of the co-morbidity of the Down syndrome (DS) and moyamoya syndrome (MMS). Among the 42 patients listed in this survey, meta-analysis permitted to find the highest number of publications by researchers from Japan and United States, followed by Brazil and Italy; prevalence of cerebrovascular disease in suckling and pre school children; first symptomatology was hemiparesis (78.6%), speech disorders (26.2%); ischemic infarction (76.2%); recurring ischemic episodes (62%); bilateral impairment (83.3%). This analysis led to the conclusion that in the clinic-neurological investigation of DS patients with acute hemiparesis episodes, MMS should be included as the most probable diagnosis.

Perfusion Imaging in the Pediatric Patient

The prevalence of cerebrovascular disease in children is much higher than most clinicians and neuroradiologists suspect, when all primary and secondary causes are considered. Most signal alterations found on MR imaging in childhood central nervous system pathologic conditions result from causes other than a decrease in tissue perfusion. In addition to conventional MR imaging, the ability to assess changes in tissue water by diffusion imaging and tissue perfusion by perfusion-weighted imaging can prove useful to asses cerebral hemodynamics in various pathologic disorders. Exogenous contrast bolus dynamic perfusion-weighted imaging is especially useful in children to differentiate between ischemic injury and other conditions that may alter T2 relaxation, such as demyelination and edema. Perfusion imaging has proved to be a robust and valuable tool to assess the hemodynamic component in childhood CNS disease related to neoplasms and complications from their therapy, cerebrovascular occlusive disease, childhood CNS arteriopathies and trauma.

Association between platelet glycoprotein Ibalpha genotype and ischemic cerebrovascular disease.

Platelets play pivotal roles in the development of ischemic cerebrovascular disease (CVD). The platelet glycoprotein (GP) Ib/IX/V complex is a receptor for von Willebrand factor, which plays a major role in the initial phase of platelet activation under high shear stress conditions. This study was designed to investigate the association between a genetic variation of this receptor and the prevalence of CVD. Two hundred patients with ischemic CVD, as confirmed by brain CT and/or MRI, and 317 age- and sex-matched control subjects without clinical evidence of CVD or cardiovascular disease were analyzed for their genotype frequencies of the (145)Thr/Met dimorphism of the alpha-chain of GPIb (GPIbalpha). Genotypes with (145)Met (T/M and M/M) were more frequently found in the CVD patients (26.5%) than in control subjects (14.2%, P=0.0005). The genotype effect was more obvious in those <60 years of age or without acquired cardiovascular risk factors. The odds ratio for nonsmoking women <60 years of age was 10. 6 (95% confidence intervals, 2.2 to 51.7). Although the number of patients studied was small (n=24), transient ischemic attack showed the highest odds ratio (4.3, P=0.0004), followed by lacunar infarction (OR=2.2, P=0.0024) and atherothrombotic infarction (OR=1. 5, P=0.3143). Logistic regression analysis revealed that the presence of Met-allele was independently associated with CVD. Our study suggests that the platelet GPIbalpha genotype is a genetic risk factor for ischemic CVD.

Novel splicing and missense mutations in autosomal dominant polycystic kidney disease 1 (PKD1) gene: expression of mutated genes.

Autosomal dominant polycystic kidney disease (ADPKD) is a common disorder mostly characterized by cyst formation in kidney tubules. The majority of ADPKD cases is caused by mutations in the PKD1 gene, but no prevalent mutation has been reported. By heteroduplex analysis of the 3' single-copy region of the gene, we have searched for mutations in subjects from 40 ADPKD families of Northern Italy. Seven novel polymorphisms and three novel disease-associated mutations (R3718Q, L3851P and IVS45+56del25) were identified. Both missense mutations are located in the major extracellular loop of polycystin-1. The 25 bp deletion inside intron 45 did not affect 5' and 3' consensus splicing sites, but caused a 56 nucleotide out of frame-deletion due to activation of a cryptic 3' splice site in exon 46. The mutated RNA should produce a truncated polycystin 1 at the G binding peptide in the intracellular C-terminal end of the protein. RT-PCR analysis showed that the disease-associated mutations were present in transcribed sequences. In particular, RNA analysis of BHK cells transfected with PKD1 genomic DNA, including the deleted intron, showed that no normal transcript is produced by the deleted gene. This intronic mutation, found in a large pedigree, seems to be associated with a prevalence of cerebrovascular disease.

Abstracts of literature

Abstracts of literature

Morbilidad por enfermedad cerebrovascular en España: incidencia y prevalencia

A descriptive study of the morbidity due to cerebrovascular disease in Spain. A review of the studies of the incidence and prevalence of cerebrovascular disease in Spain. A search of the literature available through the database MEDLINE. The annual incidence of stroke in Spain is approximately 150 per 100,000 inhabitants. The annual incidence of transient ischaemic accidents is 35-60 per 100,000 in community studies and nearly 300 per 100,000 in door-to-door studies. In the population aged over 65 years, the prevalence of stroke is 4%-8% and the prevalence of transient ischaemic accidents is 2%-3%. The incidence and prevalence figures for cerebrovascular disease in Spain are high.

Influence of risk factors on peripheral and cerebrovascular disease in men with coronary artery disease, low high-density lipoprotein cholesterol levels, and desirable low-density lipoprotein cholesterol levels

Background The Veterans Administration-HDL Intervention Trial is an ongoing, 20-center, randomized, double-blind, placebo-controlled study aiming to assess the effect of gemfibrozil-improved low high-density lipoprotein cholesterol levels on cardiovascular morbidity and mortality rates. Methods and Results Eligible patients were men with low high-density lipoprotein cholesterol levels and demonstrable coronary heart disease. A total of 2531 patients (average age 63.5 years) were randomly assigned in this study, with a mean high-density lipoprotein cholesterol level of 0.83 mmol/L (32 mg/dL) and low-density lipoprotein cholesterol level of 2.87 mmol/L (111 mg/dL). Baseline data provided the opportunity to assess the interaction of several coronary heart disease risk factors and comorbid vascular diseases. Of these patients, 206 had diabetes mellitus (DM) alone, 1021 had hypertension (HTN) alone, 421 had both DM and HTN, and 883 had neither (“others”). Considering the influence of these risk factors on comorbidities independent of smoking status, patients with DM alone had a 2-fold increase in the prevalence of peripheral vascular disease and a 1.5-fold increase in congestive heart failure. Patients with HTN had a significant increase in the prevalence of cerebrovascular disease, stroke, and congestive heart failure. Patients with HTN and DM had a significant increase in all comorbidities. Smoking resulted in substantial increase of both peripheral vascular disease and cerebrovascular disease. Compared with nonsmoking patients with no DM or HTN, patients with DM and HTN and smoking had a 3-fold increase in the prevalence of peripheral vascular disease and a 3.5-fold increase in cerebrovascular disease ( P < .001). Conclusions We conclude that DM is a strong correlate of peripheral vascular disease, hypertension of cerebrovascular disease, and that there is a strong additive effect between DM, HTN, and smoking on both. (Am Heart J 1998;136:734-40.)

在宅高齢者に対する義歯補綴治療の効果

The purpose of the study was to verify the significance of prosthodontic treatment for the elderly patients by our university's dental treatment system at home. Thirty-four patients whose dental practice was based on removable prosthodontic treatment and performed by the staff of our department were given questionnaires on satisfaction with the treatment and denture insertion. The results were as follows:1. Seventy percent of the patients were in their seventies and eighties and almost half of them were edentulous.2. ADL scores of the patients were low and most patients needed care.3. The prevalence of cerebrovascular disease was fifty-six percent in the patients.4. Ninety-four percent of the chief complaints about dental satisfaction of the patients was masticatory disturbance due to wearing uncomfortable dentures.5. Forty-seven percent of the patients needed to have their dentures replaced.6. Almost all patients answered that they were satisfied with the prosthodontic treatments offered at home.From the results of this study, removable prosthodontic treatment is significant not only for the restoration of stomatognathic function and appearance but also for the improvement of quality of life for the home bound elderly.

Vascular dementia, hypertension, and the brain

Ischemic vascular dementia is a clinical syndrome of acquired intellectual impairment with ischemic cerebral injury resulting from occlusion of cerebral blood vessels and loss of cerebral tissue caused by cerebrovascular disease. With increasing life expectancy, the developed countries have experienced a shift towards a progressively older population. As the average age ofthe population increases, the prevalence of cerebrovascular disease and vascular dementia is likely to increase. The risk of vascular dementia seems to be correlated with the epidemiologic risk factors ofstroke, namely hypertension. Hypertension is thought to be directly associated with vascplar dementia and preliminary evidence suggests an association between elevated blood pressure and impairments in cognitive functioning. Recent investigations have found significant associations between hypertension and cerebral dilation and left hemisphere atrophy, and an increased incidence of white matter hyperintensities among hypertensives. Treatment and prevention ,of vascular dementia and cognitive dysfunction in the elderly require attention to cerebrovascular risk factors, particularly hypertension. Vascular dementias are potentially preventable and cases ofAlzheimer’s disease with vascular components are becoming increasingly recognized. [Neural Res 1997; 19: 471-480]

Dose-response relationship between prevalence of cerebrovascular disease and ingested inorganic arsenic.

Circulatory diseases such as ischemic heart disease and peripheral vascular disease induced by long-term arsenic exposure have been well documented in previous studies, but the dose-response relationship between cerebrovascular disease and ingested inorganic arsenic remains to be elucidated. The prevalence of cerebrovascular disease among residents of the Lanyang Basin on the northeast coast of Taiwan was surveyed to examine its association with exposure to arsenic in well water. A total of 8102 men and women from 3901 households were recruited in this study. The status of cerebrovascular disease of study subjects was identified through home-visit personal interviews and ascertained by review of hospital medical records according to the World Health Organization criteria. Information on consumption of well water, sociodemographic characteristics, cigarette smoking, and alcohol consumption habits, as well as personal and family history of diseases, was also obtained. Arsenic concentration in the well water of each household was determined by hydride generation and atomic absorption spectrometry. Logistic regression analysis was used to estimate multivariate-adjusted odds ratios and 95% confidence intervals for various risk factors of cerebrovascular disease. A significant dose-response relationship was observed between arsenic concentration in well water and prevalence of cerebrovascular disease after adjustment for age, sex, hypertension, diabetes mellitus, cigarette smoking, and alcohol consumption. The biological gradient was even more prominent for cerebral infarction, showing multivariate-adjusted odds ratios of 1.0, 3.4, 4.5, and 6.9, respectively, for those who consumed well water with an arsenic content of 0, 0.1 to 50.0, 50.1 to 299.9, and > 300 micrograms/L. Long-term exposure to inorganic arsenic from well water was associated with an increased prevalence of cerebrovascular disease, especially cerebral infarction.

Association of levels of lipoprotein (a) and other lipoproteins with cerebrovascular disease in the Turkish population

Lipoprotein (a) [Lp (a)] is a cholesterol‐rich lipoprotein that structurally resembles the low density lipoprotein cholesterol (LDL‐C) particles, but contains a molecule of apolipoprotein (a) attached to apolipoprotein B by disulfide bond. Because of the fact that high plasma levels of Lp (a) have been shown to be associated with cerebrovascular disease (CVD), we determined plasma Lp (a) levels in CVD for the Turkish population, and compared them with previous findings of some developed countries. Plasma Lp (a) levels were evaluated in CVD and control groups. The mean plasma Lp (a) levels in the CVD group was found to be approximately two‐fold higher than that of the control group (0.21 g/1 vs 0.38 g/1). Also, it was found to be higher than the mean levels of CVD group in the other populations described in previous reports. But CVD prevalence in the Turkish population is lower than in those of developed countries, especially United States and Japan. Therefore, we believe that each of those populations should determine their plasma Lp (a) levels to observe the risk for CVD.

Prevalence of neurological disorders in a Japanese town.

The prevalence of all neurological disorders in a Japanese town was calculated, with a result of 91.1 per 1,000 population. The prevalence of cerebrovascular disease was 28.8; myelopathy and/or radiculopathy caused by deformity of the spine or disc herniation, 23.9; neuralgia, 11.5; dementia, 10.4; peripheral nerve disturbance, 5.5; epilepsy, 4.4; Parkinson's disease, 2.0; mental retardation, 2.9; brain/spinal tumor, 1.4; headache, 10.8, and vertigo/dizziness, 4.4. The prevalence of headache and vertigo/dizziness was also calculated from the results of the questionnaires sent to inhabitants: headache, 79.6, and vertigo/dizziness, 60.8. Neurological disorders are common in Japan and likely to continue to increase.

Prevalence of risk factors in acute ischemic cerebrovascular disease (CVD) in elderly patients from eastern sicily

Hundred and forty elderly patients (76 males and 64 females, over 65 years of age) were consecutively admitted to the Institute between November 1989 and April 1993, in order to (i) verify if the risk factors, reported in other Italian areas and regions of the world, are prevalent also in our region, and (ii) outline a secondary prevention strategy against the statistically most important risk factors. There were 111 cases of ischemic stroke (58 males and 53 females) and 29 cases of reversible ischemic attack (RIA) (18 males and 11 females). The percental occurrence of the following risk factors were determined: total cholesterol > 240 mg/dl, HDL cholesterol < 35 mg/dl, triglycerides > 180 mg/dl, fibrinogen > 450 mg/dl, hematocrit > 45%, hypertension, diabetes mellitus, cigarette smoking, familial ischemic events, previous ischemic CVD, ischemic cardiac disease, embolic cardiopathy. In males with ischemic stroke the most frequent risk factors were: hypertension (43%), fibrinogen > 450 mg/dl (37.9%), diabetes mellitus, cigarette smoking and previous ischemic CVD (25.8%). In females with ischemic stroke a clear prevalence of hypertension (69.8%), ischemic cardiopathy and previous ischemic CVD (47%) and diabetes mellitus (41.5%) were observed. In males with RIA hypertension (50%) and cigarette smoking (38%). Females with RIA presented a high prevalence of reduced HDL cholesterol, lower than 35 mg/dl (77.7%), hypertension (63.6%) and ischemic cardiopathy (54.5%). The results indicate that there are no highly significant differences between the data reported by other authors on the most important acute ischemic CVD risk factors in Italy and elsewhere. Arterial hypertension and diabetes mellitus are the most important risk factors of cerebral ischemic events in both sexes. The diffusion of cigarette smoking among women in the last thirty years must be taken into consideration. Although it does not represent a risk factor for elderly women today, it may do in the future. Therefore, antismoking campaigns must be more decisive and targeted at both sexes.

DNA polymorphisms at the locus for human cholesteryl ester transfer protein (CETP) are associated with macro‐ and microangiopathy in non‐insulin‐dependent diabetes mellitus

The effect of variation at the cholesteryl ester transfer protein (CETP) gene locus and in the apolipoprotein (apo) AI-CIII-AIV gene cluster on the susceptibility of individuals with non-insulin-dependent diabetes mellitus (NIDDM) to atherosclerotic vascular disease was studied in 136 male and 122 female patients with NIDDM. The prevalence of myocardial infarction was high (38%) in patients with the EcoNI genotype 2-2 of the CETP gene locus (= 2-2; subjects homozygous for the absence of the restriction site) compared with patients with the genotype 1-1 (= 1-1; subjects homozygous for the presence of the restriction site) (18%, p < 0.02). The prevalence of any evidence of coronary heart disease (CHD) (presence of ischaemic ECG changes or definite myocardial infarction) was high in 2-2 (73%) compared with the genotype 1-2 (= 1-2; heterozygous for the presence of the restriction site) (52%, p < 0.02) and genotype 1-1 (p = 0.06). CHD was more prevalent in men with 2-2 (70%) than in those with 1-1 (42%, p < 0.05), but in women no significant differences were found in the prevalences of CHD between the EcoNI genotypes. Neuropathy was more often present in the patients with 2-2 (31%) than in those with 1-1 (12%, p < 0.02) or 1-2 (14%, p < 0.01). Plasma total cholesterol and total- and VLDL-triglycerides were higher in women with the EcoNI genotype 1-1 than in those with the genotype 1-2. In men no significant differences in plasma lipids were found. In addition, the prevalence of cerebrovascular disease was high (21%) in the patients with the genotype 1-1 of the TaqIB polymorphism compared with the genotype 2-2 (6%, p < 0.02). None of the alleles defined by four polymorphisms in the apo AI-CIII-AIV gene region were associated with an increased risk for macroangiopathy. The PstI polymorphism had an effect on plasma triglyceride levels. At the CETP locus one pair of loci (TaqIB and EcoNI) and three pairs of loci at the apo AI-CIII-AIV gene cluster (SacI and MspI, SacI and PvuII and MspI and PvuII) showed significant allelic association. In conclusion, the variation of CETP locus modulates the risk for diabetic complications in patients with NIDDM and the effect seems to be different between men and women. In contrast, the AI-CIII-AIV gene cluster polymorphisms seem not to be related to the risk of CHD in NIDDM.(ABSTRACT TRUNCATED AT 400 WORDS)

High mortality and poor quality of life during predialysis period in type II diabetic patients with diabetic nephropathy.

We investigated the rate of decline in GFR and the changing prevalences of micro- and macrovascular complications in 20 type II diabetic patients [mean age 58 (46-71) years, female:male = 7:13, duration of diabetes 16 (12-30) years] from the stage of macroproteinuria with GFRs which were still normal until the beginning of dialysis or the time of death. Controls of renal function, proteinuria, HbAlc, serum lipids, and blood pressure were performed every 6 months at the beginning of the study and later on at 3-month intervals. Fundoscopy, electrocardiogram at rest and in case of need a symptom-limited treadmill ECG, a Duplex ultrasound examination of the carotid vessels, and a Doppler sonographic examination of the femoral arteries were repeated each year. The creatinine clearance (mean +/- SD) of the patients was 81 +/- 6 mL/min/1.73 m2 at the beginning of the study. The rate of decline in creatinine clearance was 1.01 +/- 0.38 mL/min/month during the whole period of observation. Twelve patients (group A) required dialysis after a mean time of 74 (40-119) months; their creatinine clearance was 7 +/- 2 mL/min/month at the beginning of renal replacement therapy. Eight patients (group B) died a short time before the beginning of dialysis treatment; their creatinine clearance was 13 +/- 5 mL/min/1.73 m2. The causes of death were sudden death (n = 4), cardiac failure (n = 1), and stroke (n = 2); in one case it was unknown. The two patient groups did not differ in respect to the mean age, duration of diabetes, HbAlc values, serum cholesterol levels, and blood pressure. The decline in the creatinine clearance was also similar in both patient groups, with 1.07 +/- 0.35 versus 0.98 +/- 0.41 mL/min/month. Only the mean serum triglyceride concentration was significantly higher in the patients who died before dialysis. At the start of the study, cerebrovascular disturbances (including plaques in the carotid vessels) were found in 30%, cardiovascular disturbances (including pathologic ECG findings) in 45%, a peripheral vascular disease in 15%, and diabetic retinopathy (grade I and II) in 75%. At the beginning of dialysis treatment or the time of death, respectively, the prevalence of cerebrovascular diseases was increased to 70% and the prevalence of cardiovascular diseases to 90%; peripheral vascular disease was present in 50% and diabetic retinopathy in all of the cases. We conclude that type II diabetic patients show high mortality (40%) and poor quality of life, not only when they require dialysis treatment, but also in the predialysis phase.