Lipids and diabetic nephropathy: hypertension, microalbuminuria and lipids in type 2 diabetic patients

Hypertension and microalbuminuria are predictors of cardiovascular mortality in type 2 (non-insulin-dependent) diabetes independently of other conventional risk factors. The presence of high triglyceride levels with small and/or dense low density lipoprotein particles is associated with cardiovascular disease. The aim of this study was to analyse the plasma lipids, Na+/Li+ countertransport (a genetic marker of hypertension) and microalbuminuria in type 2 diabetic patients. Plasma lipids were determined in 15 normotensive normoalbuminuric (H-M-), 32 hypertensive normoalbuminuric (H+M-) and 22 hypertensive microalbuminuric (H+M+) type 2 diabetic patients and in 20 sex- and age-matched non-diabetic subjects. Plasma cholesterol was significantly higher in H+M+ patients than in controls (226 +/- 38 vs 192 +/- 38 mg/dl, mean +/- SD). Plasma triglycerides were significantly higher in H+M+ patients than in either controls or H-M- patients (192 +/- 117 vs 104 +/- 59 and 115 +/- 52 respectively). The Na+/Li+ countertransport activity in red blood cells was significantly higher in H+M- and H+M+ patients than in controls, and in the type 2 diabetic patients it was directly related to plasma triglycerides (r = 0.53, P < 0.0001) and inversely to high density lipoprotein (HDL) cholesterol (r = -0.43, P < 0.0001). Microalbuminuria, hypertension and elevated Na+/Li+ countertransport activity are thus associated with high triglyceride and low HDL cholesterol levels in type 2 diabetic patients. This atherogenic lipoprotein pattern might at least partially explain the association of microalbuminuria with cardiovascular disease in type 2 diabetes