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(Circulation. 2002;106:643.)
© 2002 American Heart Association, Inc.

Editorial

Diabetic Nephropathy

Can Renoprotection Be Extrapolated to Cardiovascular Protection?

Lionel H. Opie, MD; Hans-Henrik Parving, MD

From the Hatter Institute and Department of Medicine (L.H.O.), Cape Heart Centre, University of Cape Town Medical School, South Africa; and the Steno Diabetes Center (H.-H.P.) and Faculty of Health Science, Aarhus University, Copenhagen, Denmark.

Correspondence to L.H. Opie, MD, Director, Cape Heart Centre, Hatter Institute and Department of Medicine, University of Capetown Medical School, Observatory, Capetown 7925, South Africa. E-mail Opie@capeheart.uct.ac.za

Key Words: Editorials • diabetes mellitus • angiotensin • kidney • nephropathy

An extract of the first 250 words of the full text is provided, because this article has no abstract.

Recent years have seen the seemingly unstoppable attack by cardiologists on all diseases that limit cardiovascular health. Nowhere is this more evident than in the case of diabetes mellitus, the subject of an important article in this issue of Circulation¹ that relates to renoprotection in type 2 diabetes mellitus. As a background, type 2 diabetes is increasing in incidence and cardiological significance, particularly because of the finding that blood pressure control is crucially important in limiting the macrovascular disease that shortens life in patients with type 2 diabetes.² As a negative prognostic factor, patients with type 2 diabetes without prior myocardial infarction have as high a risk of infarction as do nondiabetics with prior infarction.³ The adverse effects of type 2 diabetes are accelerated by diabetic nephropathy leading to a nearly 9-fold increase in relative cardiovascular mortality.⁴

See p 672

Renal dysfunction still remains the "Cinderella of the cardiovascular risk profile."⁵ Renal disease must start somewhere, and an increasingly attractive hypothesis suggests that early microalbuminuria warns of later proteinuria with eventual renal failure. Microalbuminuria also indicates high cardiovascular risk whether or not there is diabetes.⁶ Long-term studies show that microalbuminuria in patients with type 2 diabetes predicts later clinical proteinuria and increased early mortality^4,7–9 that is chiefly cardiovascular.¹⁰ Logically, therefore, cardiologists should be searching for microalbuminuria in all patients whenever risk is being assessed (and especially in patients with diabetes), and once found, they should be concerned with therapeutic measures to prevent deterioration. First, however, it is appropriate to examine . . . [Full Text of this Article]

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