Abstract

Introduction: Recent studies have shown that presence of microalbuminuria in diabetic patients is associated with increased incidence of silent myocardial ischemia or asymptomatic coronary artery disease, which can be a cause of increased mortality due to cardiovascular diseases. Present study was conducted to see the association of microalbuminuria with IHD in asymptomatic type-2 diabetes mellitus patients.

Material and Methods: It was a comparative, analytic type of observational study carried out atDepartment of Medicine, S.M.S. Medical College, Jaipur, Rajasthan (India) from October 2011 to September 2012. After approval from institutional ethics committee 47 normoalbuminuric and 47 microalbuminuric asymptomatic type-2 diabetes mellitus patients were taken. Patients were asked for duration and symptoms of diabetes mellitus. Peripheral pulses were palpated to detect peripheral artery disease, foot examination was done to detect any ulcer, trophic changes or signs of ischaemia. Systolic and diastolic blood pressures, weight, BMI, waist circumference and waist-hip ratio were measured, Biochemical tests like fasting and post-prandial blood sugar, serum insulin, HbA1C, total lipid profile and urine examination were done. Treadmill test and transthoracic echocardiography was done. The data were statistically analysed using chi square test and unpaired ’t’ test. P-value < 0.05 was considered as statistically significant.

Results: No significant difference was observed in age, sex, weight, BMI, waist circumference, waist-hip ratio, history of smoking and all biochemical parameters except HDL and LDL cholesterol in both the groups. Duration of type-2 diabetes mellitus, mean systolic and diastolic blood pressures were significantly associated with microalbuminuria in asymptomatic type-2 diabetes mellitus patients. Overall, 34.04% patients with microalbuminuria had evidence of silent myocardial ischemia (SMI) as compared to 6.38% normoalbuminuric subjects which was statistically significant (P<0.05). Ejection fraction was comparable in both the groups.

Conclusion: Present study showed that there was increased occurrence of silent myocardial ischemia (SMI) in asymptomatic type-2 diabetes mellitus patients who had microalbuminuria as compared to those who had normoalbuminuria.

Keywords: Type-2 diabetes mellitus, Asymptomatic, Microalbuminuria, Normoalbuminuria, Ischemic heart disease.