Proteinuria is an independent risk factor for ischemic stroke in non-insulin-dependent diabetes mellitus.
OBJECTIVE
Proteinuria is an independent risk factor for cardiovascular disease in patients with NIDDM. The aim of this study was to assess the relationship between proteinuria and ischemic stroke in subjects with NIDDM, and to determine whether proteinuria is an independent risk factor for stroke.


METHODS
We performed a case-control study of 59 diabetic patients with first-ever ischemic stroke due to thrombotic arterial occlusion, who were considered cases, and 180 diabetic patients without stroke, matched by gender, age, and diabetes duration, as a control group. WHO criteria for verified definite or possible stroke were used to ascertain the diagnosis of stroke. For the purpose of this study proteinuria was defined as a 24-hour urinary protein excretion rate of >/=20 and <200 microg/min. Risk factors included were smoking, blood pressure, body mass index, serum total cholesterol, hyperglycemia, and proteinuria.


RESULTS
Subjects with stroke had higher proteinuria proportion and systolic and diastolic blood pressures. Both frequency of antihypertensive treatment and antihypertensive drugs used were similar among subjects with and without stroke. In multivariate logistic regression analysis, the ORs and 95% CIs for the variables identified as risk factors for stroke were as follows: systolic pressure (OR 3.10; 95% CI 3.01 to 4.21; P=0.03); diastolic pressure (OR 3.30; 95% CI 1.04 to 4.48; P<0.0001); fasting glucose >/=11.1 mmol (OR 1.82; 905% CI 1.4 to 3.8; P=0.04), HbA1c >/=9.5% (OR 1.7; 95% CI 1.3 to 5.1; P<0.01), and proteinuria (OR 3.23; 95% CI 1.06 to 4.36; P<0.0001).


CONCLUSIONS
Our case-control study gives evidence that proteinuria is an independent risk factor for ischemic stroke in patients with NIDDM.
Guerrero-Romero
F
F
Medical Research Unit in Clinical Epidemiology and the Research Group on Diabetes and Chronic Illnesses, General Hospital of the Mexican Social Security Institute, Durango, Mexico. guerrero@omanet.com.mx
Rodríguez-Morán
M
M
D000368:Aged; D001786:Blood Glucose / Q000032:analysis; D001794:Blood Pressure; D002545:Brain Ischemia / Q000209:etiology*; D016022:Case-Control Studies; D002561:Cerebrovascular Disorders / Q000209:etiology*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000652:urine*; D005215:Fasting / Q000097:blood; D005260:Female; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D002542:Intracranial Embolism and Thrombosis / Q000150:complications; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D016017:Odds Ratio; D011507:Proteinuria / Q000150:complications*; D012307:Risk Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin