CARDIOVASCULAR RISK-FACTORS IN INSULIN-DEPENDENT DIABETES

Diabetics have an increased risk of cardiovascular morbidity and mortality (1-2). Compelling evidence suggests that there is cause-effect relationship between alterations of serum lipids and lipoproteins, and atherosclerosis and coronary heart disease in non diabetic-population (3-4). Among insulin dependent diabetics, the prevalence of macrovascular disease is particularly increased in those with established clinical nephropathy (5-6) and it has been partly attributed to concomitant hypertension and serum lipoprotein abnormalities (7-8). However, the effect of diabetic nephropathy and factors associated with it on Coronary Artery Disease (CAD) appears to be conditional. Many Patients in many studies did not have CAD despite a long duration of persistent proteinuria and renal failure (9-10). There is the possibility that CAD is an outcome of a multistage process, and diabetes related conditions may accelerate progression through certain stage only (11-12). In that case, the pattern of appearance of CAD would be determined by the natural history of atherosclerosis rather than by duration of diabetes. The purpose of our study is to analyze retrospectively the incidence of CAD and its association with blood pressure, serum total cholesterol, HDL cholesterol, duration of diabetes, serum triglycerides and HbA1c in a cohort of insulin dependent diabetic patients without nephropathy.