Markers of cardiovascular complications in patients with type 2 diabetes mellitus and arterial hypertension

Background: Hypertensive patients with type 2 diabetes mellitus are also at increased risk for diabetes mellitus–specific complications, including nephropathy. Even the smallest degree of albuminuria increases risk for cardiovascular diseases and all-cause death. The common conditions coexisting with type 2 diabetes (e.g., hypertension and dyslipidemia) are clear risk factors for cardiovascular diseases. Methods and materials: The first (I) group consists of 99 obtained patients with type 2 and AH, the second (II) includes 49 practically healthy people. We evaluated such markers of cardiovascular complications as glycated hemoglobin, lipid profile components by biochemical method and albumin excretion rate with the help of enzyme immunoassay. Result: The positive correlation between the level of albumin excretion rate and glycated hemoglobin (r = 0,23, p < 0,001) is confirmed that albuminuria is a main marker of diabetic nephropathy. The positive correlation between albuminuria and low density lipoproteins (r = 0,34, p < 0,001), triglycerides (r = 0,04, p < 0,001) is the definition of the important role of dyslipidemia in diabetic nephropathy. Conclusion: Determination of albumin excretion rate, glycated hemoglobin as markers of nephropathy, lipid profile components is necessary for patients with type 2 diabetes mellitus and arterial hypertension for prevention cardiovascular complications.


Introduction
Diabetes mellitus (DM) presents a growing health and socioeconomic problem nowadays.The latest International Diabetes Federation estimates indicate that 415 million (1 in 11 persons) have diabetes, and this will increase to 642 million or almost 10% of the general population by 2040.The coexistent of arterial hypertension (AH) and type 2 DM connected with increase of the risk of heart failure and stroke in 5-6 times compared with patients with AH.Moreover, the coexistence of both diseases is also associated with increased micro vascular complications like nephropathy.In high-risk patients with type 2 DM with low density lipoproteins (LDL) levels less than 2.0 mmol/L is unexpectedly related to a higher risk for cardiovascular events and all-cause mortality.Each one percentage increase of glycated hemoglobin (HbA1c) was associated with a greater increase in cardiovascular risk in white versus African American diabetic patients [1][2][3][4][5][6][7][8][9][10] .

Results and Discussion
We analyzed such markers of cardiovascular complications as albumin excretion rate, HbA1с, GCH, LDL, TG (table 1).The positive correlation between the level of albumin excretion rate and HbA1с (r = 0,23, p < 0,001) is confirmed that albuminuria is a main marker of diabetic nephropathy (DN), end-stage or which is one of the cause of death.The positive correlation between albuminuria and LDL (r = 0, 34, p < 0,001), TG (r = 0, 04, p < 0,001) is the definition of the important role of dyslipidemia in DN.Some obtained patients (5%) had the normal level of of albumin excretion rate.Also levels of urinary albumin excretion, even within the "normal" range, are associated with increasing risk for cardiovascular end points among individuals with DM 3 .
Other researches also confirmed that only LDL discordance within the DM was positively associated with cardiovascular events 8 .But some people say, that dyslipidemia in type 2 DM is, in general, characterized by elevated TG, reduced HDL cholesterol, and predominant presence of small density LDL particles 4,5 .As a result the quantity of LDL is not so important as quality.We determined the strongest correlation was confirmed between albumin excretion rate and LDL (r = 0,34, p < 0,001).

Conclusion.
In addition, determination of albumin excretion rate, HbA1с as markers of nephropathy, LDL, TG, GCH is necessary for patients with type 2 DM and AH for prevention cardiovascular complications.

Table 1 -
Markers of cardiovascular complications for patients with type 2 Diabetes mellitus and arterial hypertension Notes: n -number of patients; t -Student criteria; p -veracity of differences.We decided to analyze the correlation between albumin excretion rate and another markers of cardiovascular complications in patients with type 2 DM and AH (figure 1, 2, 3, 4).