Biomedical subjects

J G Spangler

Publications and source records attributed to J G Spangler.

38 records · Page 3Linked to original sources

PubMedDate not supplied

Hypertension, hyperlipidemia, and abdominal obesity and the development of microalbuminuria in patients with non-insulin-dependent diabetes mellitus.

BACKGROUND: The hyperlipidemia syndrome (also called syndrome X or the deadly quartet) is a recognized constellation known to increase cardiovascular mortality, but its effect on renal decline is not well-described. This study examined the differential effects of hypertension, hyperlipidemia, and abdominal obesity on overnight urinary albumin excretion ratios (UAERs) among patients with non-insulin-dependent diabetes mellitus (NIDDM), who by definition possess the remaining component of the syndrome, insulin resistance. METHODS: We conducted a survey of 317 primary care NIDDM patients measuring waist-to-hip ratios, fasting lipid levels and glycemic values, and overnight UAERs. The study was carried out between January 1989 and June 1991. RESULTS: Using logistic regression controlling for age, race, sex, duration of NIDDM, and smoking status, elevated glycosylated hemoglobin (odds ratio [OR] = 1.95, 95 percent confidence interval [CI] = 1.16-3.27) or the addition of one component of the deadly quartet to pure diabetes doubled or tripled the odds of an elevated UAER (NIDDM plus obesity OR = 2.00, 95 percent CI = 1.02-3.93; NIDDM plus hypertension OR = 3.45, 95 percent CI = 1.38-8.63; NIDDM plus hyperlipidemia OR = 1.60, 95 percent CI = 0.53-4.81). In a dose-response manner, two additional factors exerted additive effects; all three additional factors combined with pure NIDDM multiplied the effect, with an odds ratio of 9.34 (95 percent CI = 2.24-38.9). CONCLUSIONS: These data quantify the incremental effects of abdominal obesity, hypertension, and hyperlipidemia on abnormal UAERs among NIDDM patients and strongly suggest the need for aggressive and simultaneous correction of multiple risk factors to prevent end organ damage in this population.

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PubMedDate not supplied

Correlates of abnormal urinary albumin excretion rates among primary care patients with essential hypertension.

BACKGROUND: The excretion of small amounts of urinary protein, known as microalbuminuria, among patients with essential hypertension is associated with increased mortality from cardiovascular disease and, possibly, future renal decline. Correlates of microalbuminuria among primary care patients with essential hypertension, however, have not been well described. METHODS: One hundred forty patients enrolled in a large family practice ambulatory care center who had essential hypertension but not diabetes participated in a screening project to document cardiovascular and renal diseases in this population. Patients underwent a brief physical examination and submitted blood and urine samples for analysis. RESULTS: Twenty-five percent of patients had elevated urinary albumin excretion (UAE) rates, defined as greater than 30 micrograms/min. Patients with elevated UAE rates did not differ from patients without elevated UAE rates by age, race, sex, duration of hypertension, or type of antihypertensive medications used (if any). Although no patients had abnormally elevated glycosylated hemoglobin, after controlling for age and duration of hypertension, elevated UAE rates were significantly related to higher mean glycosylated hemoglobin levels (odds ratio [OR] = 3.06, 95 percent confidence interval [CI] = 1.11 to 8.41) and to current smoking (OR = 3.14, 95 percent CI = 1.09 to 9.04). CONCLUSIONS: These data are the first in a primary care population to show a threefold increase in risk for elevated UAE rates among patients with essential hypertension who currently smoke or who have above-average glycosylated hemoglobin levels. Although cross-sectional in nature, these data can also point toward subgroups of hypertensive patients who have a worse cardiovascular prognosis.

Albuminuria↗