Microalbuminuria and diabetic cardiovascular disease

Microalbuminuria is an important clinical finding in patients with diabetes because of its established association with progressive renal disease. However, it is also becoming increasingly recognized as an independent risk factor for cardiovascular disease in patients with or without diabetes. The pathogenesis of microalbuminuria in this context is still poorly understood. In patients at risk of cardiovascular disease, it is thought to reflect widespread endothelial dysfunction. There is accumulating evidence to suggest that the use of antihypertensive agents that target the renin-angiotensin system (RAS) provide cardioprotection and slow the progression of renal disease in patients with diabetes and microalbuminuria. Antihypertensive agents that target the RAS also appear to have advantages over and above reductions in systemic blood pressure. The recent Steno-2 study has demonstrated that multifactorial interventions can significantly reduce cardiovascular events in microalbuminuria patients with type 2 diabetes.