Type 2 diabetes mellitus in Canada‚s First Nations: status of an epidemic in progress

Sir, excretion of urinary albumin above 20 mg/min (microalbuminuria1) is strongly prognostic of disease and death in diabetes mellitus.2, 3 The association between albumin excretion and the risk of death is also present when other risk factors such as male sex, age, obesity, ischaemic heart disease, hypertension, smoking and raised blood lipid concentrations are taken into account1. Although the association between microalbuminuria and cardiovascular disease was initially described in individuals with diabetes, it is now well established that microalbuminuria is associated with a 1,5- to 4- fold increased risk of cardiovascular disease among individuals with and without diabetes. In fact, microalbuminuria is also associated with hypertension4 and increased cardiovascular morbidity in people who are not diabetic5.

However, the pathophysiological mechanism linking microalbuminuria to cardiovascular disease is unknown. It is important to stress that the association between microalbuminuria and cardiovascular disease is unlikely to reflect a direct, causal pathway, because there is no plausible mechanism that can directly link the quantitatively trivial urinary loss of albumin (15-300 mg per 24 hours) to atherothrombosis, as states Coen D.A. Stehouwer, MD PhD, (Why is (micro)albuminuria associated with risk of cardiovascular disease?.In: ATHERO ORG. 3 July 2002), who concludes his paper: For the present, microalbuminuria is a clinically useful marker of increased cardiovascular disease risk, even though the pathophysiological explanation of the association remains enigmatic. To recognize in a quantitative way the real arteriosclerotic risk of an individual, it is interesting to highlight the nature of link between microalbuminuria and cardiovascular diseases, but of primary importance, as regards arteriosclerosis prevention, is to go beyond microalbuminuria, in my opinion (See www.katamed.it, the Page Semeiotica Biofisica, in press). As a matter of fact, microalbuminuria takes part in most, but not all, cases of arteriosclerotic constitution. It, therefore, when present, indicates the microcirculatory abnormalities, different in location and seriousness, at the base of arteriosclerotic constitution (See my site HONCode N0 23736, http://digilander.libero.it/semeioticabiofisica: Biophysical Semeiotic Constitutions)

References

1) Mogensen CE, Chacati A Christensen CK, et al. Microalbuminuria: an early marker of renal involvement in diabetes. Uremia Investigation. 9, 85-95, 1985-6. 2) Mogensen CE. Microalbuminuria predicts clinical proteinuria and early mortality in maturity-onset diabetes. N.Engl.J.Med. 310, 356-60, 1984. 3) Mogensen CE, Scmitz A, Christensen CK. Comparative renal pathophysiology relevant to IDDM and NIDDM patients. Diabetes/Metabolism Reviews. 4, 453-83, 1988. 4) Damsgaard EM, Mogensen CE. Microalbuminuria in elderly hyperglicaemic patients and controls.Diabetic Med. 3, 430-5, 1986. 5)Yudkin JS, Forrest RD, Jakson CA. Microalbuminuria as predictor of vascular disease in non diabetic subjects. Lancet.ii, 530-33, 1988.