Cardiovascular disorders and possibilities of their therapy in patients with type 2 diabetes mellitus and diabetic nephropathy
Onuchin, S.G.; Elsukova, O.S.; Solov'ev, O.V.; Onuchina, E.L.
Klinicheskaia Meditsina 88(1): 32-37
2010
ISSN/ISBN: 0023-2149 PMID: 20369609 Document Number: 644171
The aim of the study was to assess specific cardiovascular lesions in patients with type 2 diabetes mellitus and diabetic nephropathy (DN) and search for the methods of their correction. It included 182 overweight or obese (abdominal type) women above 55 yr with arterial hypertension (AH) divided into groups with normal or low (less than 30 ml/day) albuminuria (n = 87), albuminuria (30-300 mg/day, n = 59), proteinuria (above 30 mg/day, n = 21), and stage I-IIa chronic renal insufficiency (CRI, n = 15). It was shown that structural geometric changes in the left ventricle (LV) with the prevalence of myocardial concentric hypertrophy and diastolic dysfunction (DD), enhanced myocardial hardness, and preserved systolic function undergo progression with increasing severity of DN and decreasing glomerular filtration rate combined with poorly controlled DM2, abnormal lipid profile, long history of AH in the absence of adequate AP control, signs of vascular atherosclerosis (thickening of intima and media in carotid arteries), and large number of macrovascular complications. DN-related insulin resistance (IR) was a factor influencing LV remodeling and DD. Long-term combined therapy affecting IR and markers of cardiovascular disorders (AH, chronic hyperglycemia, dyslipidemia) promoted improvement of LV diastolic function, reverse remodeling of LV myocardium, decrease of atherosclerotic lesions and albuminurea in patients presenting with both low albuminuria and DN; in addition, it improved prognosis of the disease.