Summary
Fifty-nine Type 1 (insulin-dependent) diabetic patients with (group I) and 59 patients without nephropathy (group II) pair-matched according to sex (30 males and 29 females), age (33 years, range 15–48) and diabetes duration (19 years, range 6–42) were followed for a period of 10 years from about 5 years before to 5 years after onset of proteinuria. The cumulative incidence of coronary heart disease was estimated, and blood pressure and serum cholesterol were followed. Within six years after onset of proteinuria the cumulative incidence of coronary heart disease was increased eight-fold in group I (40%) compared with group II (5%), (p<0.001). Blood pressure was higher in group I compared with group II from before onset of proteinuria (135/86±17/9 mmHg vs 129/80±15/8 mmHg, p<0.001), and serum cholesterol elevated from onset of proteinuria in group I (6.3±1.2 mmol/l) vs. group II (5.5±1.0 mmol/l), (p<0.005). Patients in group I who developed coronary heart disease had similar age (36 years, range 21–51, vs 38 years, range 21–53), sex (50% males vs. 52% males), smoking frequency (50% vs 49%), diabetes duration (22 years, range 9–39, vs 24 years, range 10–42) and serum creatinine (110 μmol/l, range 69–284, vs 108 μmol, range 72–1024) compared with patients not developing coronary heart disease. However, the patients with coronary heart disease had higher blood pressure (135/87mmHg±16/9 vs 128/82±15/7, p<0.05) and serum cholesterol (7.3 mmol/l+ 1.2 vs 6.4 mmol/l±0.9, p<0.05) than patients without coronary heart disease. Thus, patients developing clinical nephropathy have a highly increased incidence of coronary heart disease compared with patients not developing nephropathy. Patients who developed coronary heart disease were characterized by higher blood pressure and serum cholesterol.
Article PDF
Similar content being viewed by others
References
Kannel WB, McGee DL (1979) Diabetes and cardiovascular disease. The Framingham study. JAMA 241: 2035–8
Jarrett RJ, McCartney P, Keen H (1982) The Bedford Survey. Ten-year mortality rates in newly diagnosed diabetics and normoglycaemic controls and risk indices for coronary heart disease in borderline diabetics. Diabetologia 22: 79–84
Borch-Johnsen K, Kragh Andersen P, Deckert T (1985) The effect of proteinuria on relative mortality in Type 1 (insulin-dependent) diabetes mellitus. Diabetologia 28: 590–96
Mogensen CE (1984) Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N Engl J Med 6: 356–60
Jarrett RJ, Viberti GC, Argyropoulos A, Hill RD, Mahmud U, Murrells TJ (1984) Microalbuminuria predicts mortality in non-insulin-dependent diabetes. Diabetic Med 1: 17–9
Weinrauch L, D'Elia JA, Healy RW, Gleason RE, Christlieb AR, Leland OS (1978) Asymptomatic coronary artery disease: angiographic assessment of diabetics evaluated for renal transplantation. Circulation 58: 1184–90
Seneveratne BIB (1977) Diabetic cardiomyopathy: the preclinical phase. Br Med J 1: 1444–6
Sanderson JE, Brown DJ, Rivellese A, Kohner E (1978) Diabetic cardiomyopathy? An echocardiographic study of young diabetics. Br Med J 1: 404–7
Parving HH, Andersen AR, Smidt UM, Oxenbøll B, Edsberg B, Sandahl Christiansen J (1983) Diabetic nephropathy and arterial hypertension. Diabetologia 24: 10–12
Feldt-Rasmussen B, Borch-Johnsen K, Mathiesen ER (1985) Hypertension in diabetes as related to nephropathy. Early blood pressure changes. Hypertension 7 [suppl II]: II-18–II-20
Christiansen JS (1978) Cigarette smoking and prevalence of microangiopathy in juvenile onset insulin-dependent diabetes mellitus. Diabetes Care 1: 146–49
Feldt-Rasmussen B (1986) Increased transcapillary escape rate of albumin in Type 1 (insulin-dependent) diabetic patients with microalbuminuria. Diabetologia 29: 282–6
Valdorf-Hansen F (1967) Coagulability in diabetics. Acta Med Scand, Supplementum 476: 147–57
Blackburn H, Keys A, Simonsen E, Rautaharju P, Punsar S (1960) The electrocardiogram in population studies: a classification system. Circulation 21: 1160–75
Rose G, Blackburn H (1968) Cardiovascular survey methods. World Health Organization Monograph Series No. 56 WHO Geneva
Rose GA (1962) The diagnosis of ischaemic heart pain and intermittent claudication in field surveys. Bull WHO 27: 645–658
Abell LL, Levy BB, Biodie BB, Kendall FE (1952) A simplified method for the estimation of total cholesterol in serum and demonstration of its specificity. J Biol Chem 195: 357–60
Larsen K (1972) Creatinine assay by a reaction-kinetic principle. Clin Chim Acta 41: 209–17
Tsuchiya (1908) Eine neue volumetrische Eiweissbestimmung mittels der Phosphorwolframsaure. Zenhalbl Inn Med 29: 105–115
Zoneraich S, Silverman G, Zoneraich O (1980) Primary myocardial disease, diabetes mellitus, and small vessel disease. Am Heart J 100: 754–5
Regan TJ, Lyons MM, Ahmed SS, Levinsson GE, Oldewurtel HA, Ahmad MR, Harder B (1977) Evidence for cardiomyopathy in familial diabetes mellitus. J Clin Invest 60: 885–99
Shapiro LM, Leatherdale BA, Mackinnon J, Fletcher RF (1981) Left ventricular function in diabetes mellitus. II: Relation between clinical features and left ventricular function. Br Heart J 45: 129–32
Borch-Johnsen K, Kreiner S (1986) Proteinuria predicts high relative mortality of cardiovascular disease in Type 1 (insulin-dependent) diabetic patients. Diabetologia 029: 521A
Baxter JH, Goodman HC, Havel RJ (1960) Serum lipid and lipoprotein alterations in nephrosis. J Clin Invest 39: 455–65
Appel GB, Blum CB, Shu Chien, Kunis CL, Appel AS (1985) The hyperlipidemia of the nephrotic syndrome. Relation to plasma albumin concentration, oncotic pressure and viscosity. N Engl J Med 312: 1544–48
Marsh JB, Sparks CE (1979) Hepatic secretion of lipoproteins in the rat and the effect of experimental nephrosis. J Clin Invest 64: 1229–37
Christlieb AR (1982) The hypertensions of diabetes. Diabetes Care 5: 50–8
Lipid Research Clinics Program (1984) The Lipid Research Clinics Coronary Primary Prevention Trial Results. JAMA 251: 351–74
Author information
Authors and Affiliations
Rights and permissions
About this article
Cite this article
Jensen, T., Borch-Johnsen, K., Kofoed-Enevoldsen, A. et al. Coronary heart disease in young Type 1 (insulin-dependent) diabetic patients with and without diabetic nephropathy: incidence and risk factors. Diabetologia 30, 144–148 (1987). https://doi.org/10.1007/BF00274218
Received:
Revised:
Issue Date:
DOI: https://doi.org/10.1007/BF00274218