relatia dintre microalbuminurie si ateroslceroza carotidiana-subiect de controverse

1. Ateroscleroza carotidiana si relatia cu
micro-Albuminuria in DZ de tip 2
Andritoiu Alexandru
Sp. Militar Craiova

2. Relatia DZ-CbVDRelatia DZ-CbVD

3. CIMT in DZ

4. CIMTCIMT
• Masuratori manuale
• Masuratori automate
VN <0.9 mm

5. CIMT

6. 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

8. Carotid Intima-Media Thickness in Patients With Type 2 DiabetesCarotid Intima-Media Thickness in Patients With Type 2 Diabetes
The significance of microalbuminuria and different risk factors forThe 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 ACEtype 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

11. 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.

15. 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

16. Exista o relatieExista o relatie
ATS CAR-microAlbuminurie laATS CAR-microAlbuminurie la
pacientii diabeticipacientii diabetici
???????????????????????????

17. 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

18. Metoda de studiuMetoda de studiu
• US-CAR
• CIMT (masurare manuala)
• Scor placi CAR
• frecv. placi CAR
• Dozare microAlb (urine sample)
• Analiza statistica (MedCalc)

19. Loturile de studiuLoturile de studiu
ParametruParametru Lot ALot A Lot BLot B
Varsta (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

20. 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)

21. Plaques score-analizaPlaques score-analiza
multivariatamultivariata
ParametruParametru 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)

22. Relatia MicroAlb-ATS CARRelatia MicroAlb-ATS CAR
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)

23. 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 CAR
75%
41,66%
HbA1c<6,5% HbA1c>6,5%
p=0.007
p=0.01

24. 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

25. 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.