Early Renal Abnormalities as an Indicator of Cardiovascular Risk in Type 2 Diabetes
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REVIEW ARTICLE
Early Renal Abnormalities as an Indicator of Cardiovascular Risk in Type 2 Diabetes Francesca Viazzi • Barbara Bonino • Elena Ratto • Salvatore De Cosmo • Roberto Pontremoli
Received: 19 July 2014 / Accepted: 24 July 2014 / Published online: 1 August 2014 Ó Springer International Publishing Switzerland 2014
Abstract Accurate assessment of cardiovascular (CV) risk is a prerequisite for devising effective therapeutic strategies in patients with type 2 diabetes (T2DM) as it allows to refine prognosis and treatment targets as well as the cost-benefit ratio for specific pharmacological interventions. The presence of subclinical vascular organ damage plays a well known role in determining overall risk and a wider use of low cost, easy to perform diagnostic tools to stratify CV risk is very much needed. Besides their well known prognostic value for progression to end stage renal disease (ESRD), subclinical renal abnormalities such as microalbuminuria and/or a slight reduction in estimation of glomerular filtration rate (eGFR), have been shown to be powerful, independent predictors of CV diseases in patients with T2DM. Through the combined evaluation of these two biomarkers of chronic kidney disease (CKD), clinicians can usefully and reliably get a perspective on global and CV outcome of their diabetic patients. Keywords Diabetes Cardiovascular risk Microalbuminuria Glomerular filtration rate Chronic kidney disease
F. Viazzi B. Bonino E. Ratto R. Pontremoli (&) Universita` degli Studi and I.R.C.C.S. Azienda Ospedaliera Universitaria San Martino-IST, Viale Benedetto XV, 16125 Genoa, Italy e-mail: [email protected] S. De Cosmo Unit of Internal Medicine, Scientific Institute, San Giovanni Rotondo, Italy
1 Introduction Accurate assessment of CV risk is a prerequisite for devising effective therapeutic strategies in patients with T2DM as it allows to refine prognosis and treatment targets as well as the cost-benefit ratio for specific pharmacological interventions. Thus, for example, according to almost all international guidelines, each patient’s individual burden of risk may dictate blood pressure values for starting antihypertensive treatment or the preferred type of drug as well as the opportunity to start antiplatelet agents or lipid profile correction [1]. Besides previous history and risk factors that are traditionally associated with diabetes, such as hypertension and lipid abnormalities, the presence of subclinical vascular organ damage plays a well known role in determining global risk and therefore in tailoring therapeutic choices to the individual patient [2]. However, in the context of the ongoing epidemic of T2DM and because of population aging, both of which place a growing logistic and economic burden on public health systems, a broader use of low cost, easy to perform diagnostic tools to stratify CV risk is very much welcome. CKD has traditionally been acknowledged as a devastating microvascular complication of long standing diabetes and a multiplier of vascular risk [3
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