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Microalbuminuria, Lipoproteins, and Diabetic Control
- Andrew G. Bostom, MD; and
- Peter W. F. Wilson, MD
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TO THE EDITOR:
In their cross-sectional analysis, Ramirez and colleagues [1] provide no data regarding microalbuminuria, nor did the preliminary studies cited by Ramirez and colleagues show either a cross-sectional (their references 30 and 32), or short-term longitudinal (their reference 31) relation between lipoprotein (a) (Lp[a]) level and glycemic control. Categorizing either insulin- or non–insulin-dependent diabetics by the presence or absence of the nephrotic syndrome is insufficient when assessing their Lp(a) levels and the possibly related risk for accelerated atherosclerotic disease.
Karadi and colleagues [2], the first to report significantly increased Lp(a) concentrations in association with nephrosis, found no correlation between daily protein loss or selectivity index and Lp(a) concentration. Jenkins and colleagues [3] reported that apolipoprotein (a) (apo [a]) levels in insulin-dependent diabetics (n = 107) were elevated in those with microalbuminuria and did not correlate with glycemic control. Patients with microalbuminuria had significantly higher apo (a) levels (geometric mean, 245 U/L compared with 196 U/L; P < 0.005), despite glycosylated hemoglobin (HbA1c) concentrations that were significantly lower than those in the albuminuric patients (mean, 8.8% compared with 9.8%; P < 0.05).
Microalbuminuria is predictive of increased mortality in non–insulin-dependent diabetes [4]. Data from the original population-based Framingham cohort suggest that trace proteinuria determined by dipstick is associated with significantly increased overall and cardiovascular disease-related mortality [5]. The interrelation of quantitative microalbuminuria, Lp(a), HbA1c, and cardiovascular disease should be examined prospectively in a population that includes persons with normal glucose tolerance, documented glucose intolerance, and overt diabetes mellitus.
The Editors welcome submissions for possible publication in the Letters section. Authors of letters should:
•Include no more than 300 words of text, three authors, and five references
•Type with double-spacing
•Send three copies of the letter, an authors' form signed by all authors, and a cover letter describing any conflicts of interest related to the contents of the letter.
Letters commenting on an Annals article will be considered if they are received within 6 weeks of the time the article was published. Only some of the letters received can be published. Published letters are edited and may be shortened; tables and figures are included only selectively. Authors will be notified that the letter has been received. If the letter is selected for publication, the author will be notified about 3 weeks before the publication date. Unpublished letters cannot be returned.
Annals welcomes electronically submitted letters.
- Copyright ©2004 by the American College of Physicians
