Gender difference in albuminuria and ischemic heart disease in type 2 diabetes.
OBJECTIVE
The value of urinary albumin excretion in the prediction of myocardial ischemia in men and women with type 2 diabetes is not well understood. We questioned whether gender influences the albuminuria-ischemic heart disease relationship in patients with type 2 diabetes.


METHODS
We designed a matched case-control study of 926 patients with albuminuria (cases) and 926 age and body mass index matched patients without albuminuria (controls). Ischemic heart disease was defined as the presence of (1) history of angina pectoris or angina equivalent symptoms and critical care unit admission, (2) myocardial infarction and/or electrocardiographic evidence of Q-wave myocardial infarction, (3) coronary revascularization and/or stenting, (4) positive myocardial single-photon emission computed tomography scan, (5) ischemic ST-segment or T-wave changes, and (6) positive stress testing.


RESULTS
Patients with albuminuria had a lower glomerular filtration rate and a longer diabetes duration than patients without albuminuria. In the group of cases, there were a greater number of men with ischemic heart disease (120 of 370; 32.4%) compared to women (97 of 559; 17.4%) (P<0.001). The odds ratio of having ischemic heart disease according to the presence or absence of albuminuria was 1.25 [95% CI: 1.01-1.56] (P<0.05) in all studied populations, 0.79 [95% CI: 0.51-1.21] (P=0.14) in women, and 2.84 [95% CI: 1.68-4.79] (P<0.001) in men. We showed that diabetes duration, high-density lipoprotein, low-density lipoprotein, and hemoglobin A(1c) influence albuminuria in women, while diabetes duration, fasting blood sugar, and diastolic blood pressure influence albuminuria in men.


CONCLUSIONS
Men with albuminuria are at increased risk of ischemic heart disease compared to women. This may be related to the role of high-density lipoprotein on the albuminuria-gender relationship.
Endocrinology and Metabolism Research Center-EMRC, Vali-Asr Hospital, Tehran University of Medical Sciences, PO Box 13145-784, Tehran, Iran. nakhjavanim@tums.ac.ir
Manouchehr
M
Nakhjavani
Afsaneh
A
Morteza
Yaser
Y
Jenab
Azam
A
Ghaneei
Alireza
A
Esteghamati
Maryam
M
Karimi
Alireza
A
Farokhian
D000419:Albuminuria / Q000150:complications*; D001786:Blood Glucose / Q000032:analysis; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D005260:Female; D005919:Glomerular Filtration Rate; D006442:Glycated Hemoglobin / Q000032:analysis; D006801:Humans; D008075:Lipoproteins, HDL / Q000097:blood; D008077:Lipoproteins, LDL / Q000097:blood; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000150:complications*; D016017:Odds Ratio; D012307:Risk Factors; D012737:Sex Factors
D001786:Blood Glucose; D006442:Glycated Hemoglobin; D008075:Lipoproteins, HDL; D008077:Lipoproteins, LDL