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Prothrombotic and antithrombotic factors are elevated in patients with type 1 diabetes complicated by
1University Department of Medicine, St Vincent's Hospital, Melbourne, Australia.
Insights
Diabetic renal disease elevates prothrombotic factors like fibrinogen and Factor VIIc, increasing vascular disease risk. Antithrombotic factors also rise, but without a known protective effect in these patients.
Area of Science:
- Cardiovascular Medicine
- Nephrology
- Endocrinology
Background:
- Increased urinary albumin loss in Type 1 diabetes is linked to accelerated atherosclerosis.
- Prothrombotic and antithrombotic factors are crucial in vascular disease development.
Purpose of the Study:
- To investigate alterations in prothrombotic and antithrombotic factors in Type 1 diabetic patients with varying urinary albumin loss.
- To determine the association between these haemostatic factors and diabetic renal disease.
Main Methods:
- Studied 52 Type 1 diabetic patients and 24 non-diabetic controls.
- Measured urinary albumin loss and levels of fibrinogen, Factor VIIc, protein C, protein S, and antithrombin III.
Main Results:
- Fibrinogen and Factor VIIc levels increased significantly with microalbuminuria and albuminuria compared to controls and diabetics without microalbuminuria.
- Levels of antithrombotic factors (protein C, protein S, antithrombin III) also rose in diabetic patients with renal damage.
Conclusions:
- The observed pattern of elevated prothrombotic factors in diabetic renal disease may contribute to the increased risk of vascular disease.
- The simultaneous rise in antithrombotic factors without a known protective effect warrants further investigation.
Abstract:
Increased urinary albumin loss in patients with Type 1 diabetes is associated with accelerated atherosclerosis. Prothrombotic factors known to be associated with cerebrovascular and coronary artery disease in the general population, antithrombotic factors, were studied in 52 patients with Type 1 diabetes and varying urinary albumin loss and 24 non-diabetic control subjects. Fibrinogen increased from 2.5 g l-1 (95% confidence interval 2.3-2.8) in control subjects and 2.8 g l-1 (2.6-3.0) in diabetic patients without microalbuminuria to 3.1 g l-1 (2.7-3.5) with microalbuminuria (p < 0.005 vs control; p < 0.001 vs without microalbuminuria). Factor VIIc increased from 81% (75-86% in non-diabetic control subjects and 84% (78-90%) in diabetic patients without microalbuminuria to 103% (89-117%) with microalbuminuria (p < 0.005 vs control; p < 0.05 vs without microalbuminuria) and 118% (86-150%) with albuminuria (p < 0.005 vs control and p < 0.001 vs without microalbuminuria). Levels of the antithrombotic factors protein C, protein S, and antithrombin III also rose in the diabetic patients with evidence of renal damage. Elevation of prothrombotic factors has been associated with increased risk of microvascular disease, whereas elevation of antithrombotic factors has no known protective effect. Therefore, this pattern of alteration of haemostatic factors in diabetic renal disease may contribute to the increased risk of vascular disease associated with both microalbuminuria and albuminuria.