[Dyslipidemia and cardiovascular risk in type 2 diabetes mellitus patients with associated diabetic nephropathy].Nefrologia. 2002; 22 Suppl 1:51-8.N
Diabetes patients with concomitant diabetic nephropathy are especially destined to cardiovascular complications due to the presence of microalbuminuria or proteinuria, that are potent inductors of dyslipidaemia.
We have studied 98 type 2 diabetes mellitus patients, 61 male and 37 female, mean age 63 +/- 13 year old, all of them with overt proteinuria (above 500 mg/day), divided into 4 groups: G-I (n = 13): patients with t. cholesterol > 6.25 mmol/l treated with fibric-acid derivatives; G-II (n = 52): hypercholesterolemic patients treated with statins; G-III (n = 20): hypercholesterolemic patients with no lipid-lowering intervention; G-IV (n = 13): normocholesterolemic patients (control group). Lipidic profile, proteinuria and renal function have being compared after 1, 3 and 5 years.
Base-line characteristics of the patients were similar when regarding age, onset of diabetes or nephropathy. Only proteinuria was higher in statins-treated group (p < 0.05). Fibric-acid derivatives were more effective on hypertriglyceridaemia while statins were more effective lowering LDL cholesterol. A gemfibrocyl-treated patient presented a rhabdomyolysis episode. Statins were safe and well tolerated. Nine patients (19%) in G-II, 2 patients (10%) in G-III and 1 patient (7%) in G-IV achieved end-stage renal failure. Five-year cardiovascular mortality and all-cause mortality rate were 23%/23% in G-I, 13%/19% in G-II, 20%/25% in G-III and 31%/31% in G-IV. The difference was statistically significant when comparing normocolesterolemic versus statin-treated patients (p < 0.05).
Lipid-lowering therapy could probably delay but not avoid the progression of diabetic nephropathy. Since dyslipidaemia is closely related to the progression of cardiovascular disease and mortality, an aggressive lipid-lowering therapy is recommended, irrespectively of its potential effect on diabetic nephropathy.