INTRODUCTION: 1 Diabetes mellitus is the most common metabolic disorder. The incidence of cardiovascular diseases in patients with Type 2 Diabetes Mellitus is increasing nowadays. Assessment of cardiovascular risk in patients with Type 2 Diabetes Mellitus is the primary concern in managing these patients. Microalbuminuria is a known important risk factor for Kidney disease. Recent studies have highlighted Micro albuminuria as an independent marker for endothelial dysfunction and 2 cardiovascular diseases. Microalbuminur ia is a consequence of vascular diseases. Albumin leakage into 3 urine is a reection of widespread vascular damage. Microalbuminuria is dened as the excretion of 30-300 µg of albumin per mg Creatinine excreted in a spot urine sample or 30-300mg of Albumin excreted per day in a 24 hours urine 4 sample. Microalbuminuria is highly prevalent in patients with 4Diabetes Mellitus, its prevalence ranging from 10 to 40 % . In India, the prevalence of Microalbuminuria varies from 19.7 to 128.5 % in patients with Type 2 Diabetes Mellitus. A duration of more than 6 years may have existed before the patients are diagnosed with Type 2 Diabetes mellitus, due to its insidious onset. As a result, patients often present with 5Microalbuminuria at the time of diagnosis. Microalbu minuria leads to increased risk of Cardiovascular diseases 6and Death. Studies have reported that the risk factors for Cardiovascular disease such as the fasting Lipid prole varied signicantly between type 2 Diabetes Mellitus patients with and without Microalbuminuria. This study is to evaluate the prevalence of Microalbuminuria in recently diagnosed cases of Type 2 Diabetes Mellitus and to study the correlation of the parameters of fasting Lipid prole and Microalbumin excretion in these patients, so that Microalbuminuria can be used as an independent marker for early prediction of Cardiovascular complications and can be used as a screening procedure in all patients diagnosed with type 2 Diabetes mellitus. REVIEW OF LITERATURE: Microalbuminuria is dened as excretion of low levels of albumin in urine about 30 to 300 mg/dl. The prevalence of 7,8,9, 10,11Microalbuminuria varies from 10 to 40% . It is urinary excretion of albumin that is persistently increased above normal levels, but below the sensitivity of conventional semi- 12quantitative test strips . Microalbuminuria has been proposed as a strong and independent indicator of increased cardiovascular risk in subjects with and without diabetes. Endothelial dysfunction and chronic low-grade, subclinical inammation has been implicated as a common pathophysiologic process in the association between microalbuminuria and cardiovascular 13,14,15,16,17,18disease . Physiologically, the glomerular lter forms a barrier to prevent macromolecules from reaching the urinary space. The proximal tubule has an effective albumin reabsorption system that metabolizes albumin, so that urine contains no or only small quantities of albumin. Increase in albumin excretion reects the loss of ltration power of glomerulus due to 4,10,19damage of Glomerular endothelial cells (podocytes) . The incidence of subclinical atherosclerosis is increased in type 2 diabetic patients with microalbuminuria, Insulin 20,21,22resistance and hyperglycemia . The pathophysiological process of atherosclerosis is mainly due to endothelial dysfunction. Impaired endothelium leads to increased susceptibility to thrombus formation, increased adhesion of platelets and increased transmigration of leukocytes. The normal blood ow maintenance is by prostacyclin and nitric oxide which inhibits platelet activation. People with DM have reduced prostacyclin and NO, due to a chronic impairment of endothelial NO synthase activity. This also has been proposed as a mechanism of Atheroma MICROALBUMINURIA – AN INCREASINGLY RECOGNIZED CARDIOVASCULAR RISK FACTOR Original Research Paper Dr. S. Aruna, M.d.* Assistant Professor, Department Of Biochemistry, Karur Govt. Medical College, Karur *Corresponding Author X 1GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS Biochemistry AIM: The Aim of the study is to determine the prevalence of Microalbuminuria in newly diagnosed patients with Type 2 Diabetes Mellitus and to compare the effectiveness of Microalbuminuria with the fasting Lipid prole in detecting Cardiovascular risk in these patients in terms of Atherogenic Index. Material &Methods: The study group includes 100 patients with Type 2 Diabetes Mellitus. Patients with urinary tract infection, Macro albuminuria, Renal failure and Heart failure are excluded from the study. Fasting and post-prandial blood sugar, Fasting Lipid prole, Atherogenic Index, Creatinine and Urine Albumin are measured in all the patients. The patients were divided in to two groups: Group A without Microalbuminuria and Group B with Microalbuminuria. RESULTS: BMI, FBS, PPBS, Total Cholesterol, TGL, Atherogenic Index, Creatinine and Urine Albumin are found to be higher in Group B compared to Group A patients and Serum HDL is found to be lower in Group B compared to Group A patients. Pearson correlation coefcient of Atherogenic Indices with Urine Albumin excretion of Group B patients shows that there is a signicant positive correlation (r = 0.5981). CONCLUSION: Microalbuminuria can be used as an independent marker for early prediction of Cardiovascular complications and can be used as a screening procedure in all patients diagnosed with type 2 Diabetes mellitus. ABSTRACT KEYWORDS : Microalbuminuria, Atherogenic Index, Cardiovascular Diseases, Diabetesmellitus. Dr. J. Sowndharya, M.d. Tutor, Department Of Biochemistry, Karur Govt. Medical College, Karur Dr. R. S. Monish Anand, M.b.b.s. VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 2 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS 22formation in patients with type 2 Diabetes mellitus . The endothelial function in type 2 Diabetes mellitus patients 23has a negative correlation with microalbuminuria .The leakage of albumin through Glomerulus reects a widespread atherosclerosis-mediated capillary vascul 24opathy .Angiographic studies proved that the extent of endothelial dysfunction correlates with the degree of albumin 10excretion .Microalbuminuria is an index of vascular 25,26damage . Urinary excretion of large amounts of proteins may lead to increased serum levels of total cholesterol and LDL- 27cholesterol .The number of patients attending Cardiology outpatient setting is increasing, indicating that cardiov ascular high risk is common and possibly underes 23timated .Microalbuminuria can be used as a prognostic factor for morbidity and mortality due to Cardiovascular 25,28,29diseases in Type 2 Diabetes patients . There is evidence that reduction of albuminuria leads to improvement in the risk 11proles of patients with type 2 Diabetes Mellitus . Lipid prole and Atherogenic index have been shown to be 30,31signicant predictors for metabolic disturbances . Atherogenic index was calculated by the formula = log (TG/HDL-C). Friedewald formula is used for calculating LDL and VLDL. 30,31VLDL = TG/5, LDL = Total Cholesterol-(VLDL+HDL). Atherogenic Index has been found to be an independent determinant of chronic subclinical inammation in patients 32with type2 diabetes mellitus .The Atherogenic index of plasma has been positively correlated with cholesterol, TG, LDL, VLDL and negatively correlated with HDL and the 33correlation is found to be statistically signicant .Compared to conventional Lipid levels, ratios such as TG/HDL-C have a better statistical link with the prevalence and severity of 34Coronary Artery disease . AIMS & OBJECTIVES: 1. To determine the prevalence of Microalbuminuria in newly diagnosed patients with Type 2 Diabetes Mellitus. 2. To compare the effectiveness of Microalbuminuria with the fasting Lipid prole in detecting Cardiovascular risk in these patients in terms of Atherogenic Index. MATERIALS & METHODS: The current study is a cross-sectional study and carried out for a period of two months. The study group includes 100 patients with Type 2 Diabetes Mellitus. The patients are selected from those attending Diabetic Out Patient Department. Informed written consent was obtained from all the 100 participants. INCLUSION CRITERIA: Patients with recently diagnosed Type 2 Diabetes Mellitus (within 2 years of diagnosis) and age less than 40 years. EXCLUSION CRITERIA: Patients presenting with 1. Urinary tract infection 2. Macro albuminuria 3. Renal failure 4. Heart failure of any stage. METHODOLOGY: BMI (Body Mass Index) is calculated and it is expressed as 2. (35)Kg/m . Fasting and postprandial blood samples and early morning urine samples are collected from the selected patients. In the fasting blood sample, plasma Glucose, serum Lipid prole and serum Creatinine are measured. In the post prandial blood sample, plasma glucose is measured. In the early morning collected urine sample, Microalbumin is measured. The parameters are determined using semi-auto analyzer. Plasma glucose is measured by Glucose oxidase - Peroxidase Enzymatic method, Serum Creatinine by Alkaline Picrate method, serum Total Cholesterol by Cholesterol Oxidase- Peroxidase method, serum Triglycerides by Enzymatic Colorimetric method, serum HDL – cholesterol by Phosphotungstate/magnesium precipitation method and urine Microalbumin by Turbidimetric Immunoassay method. LDL is calculated by the Friedewald formula. VLDL is (30)calculated by the formula TGL/5 . OBSERVATION & RESULTS: The patients were divided into two groups: Group A, without Microalbuminuria and Group B, with Microalbuminuria. Atherogenic Indices were calculated by using the following 35,30,31equation log (Triglycerides / HDL cholesterol) . STATISTICAL ANALYSIS: All values are presented as Mean ± Standard Deviation. The results were statistically analyzed by using student's 't'test and by Pearson's correlation coefcient using Microsoft Excel Worksheet. 'p' Value <0.05 is considered as signicant. The study consisted of 100 patients out of which 54 patients had no Microalbuminuria and 46 patients had Microalb uminuria. The Prevalence of Microalbuminuria is 46% in newly diagnosed cases of diabetes Mellitus. TABLE-1: Shows the Biochemical Characteristics of the study - Mean, Standard deviation and unpaired T test correlation between Group A and Group B. TABLE-2: Shows the Pearson correlation of Atherogenic Indices with Urine Albumin excretion of Group B patients. VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra S.No. BMI FBS PPBS T.CHOL TGL HDL Group A 27.2±1.74 100.9±16.52 234±104.61 183.8±36.49 97.4±16.91 38.6±2.35 Group B 27.6±1.39 115.7±16.85 288.5±104.8 200.3±28.21 140.5±27.63 35.6±4.93 p value <0.5 Signicant <0.001 Signicant <0.005 Signicant <0.05 Signicant <0.001 Signicant <0.001 Signicant TABLE 1: TABLE 2: DISCUSSION: The results show that BMI, FBS, PPBS, Total Cholesterol, TGL, Atherogenic Index, Creatinine and Urine Albumin to be higher in Group B compared to Group A patients and Serum HDL is found to be lower in Group B compared to Group A patients. S.No. CREAT A.I. M.ALB. Group A 27.2±1.74 100.9±16.52 234±104.61 Group B 27.6±1.39 115.7±16.85 288.5±104.8 P value <0.001 Signicant <0.001 Signicant <0.001 Signicant 1. 0.5981 (Signicant positive correlation) S.No. Pearson Correlation Coefcient X 3GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra Pearson correlation coefcient of Atherogenic Indices with Urine Albumin excretion of Group B patients shows that there is a signicant positive correlation (r = 0.5981). So, from the results obtained it is clear that the Lipid prole is deranged in a signicant manner in type 2 Diabetes Mellitus patients with Microalbuminuria (Group B) compared to those with Type 2 Diabetes Mellitus without Microalbuminuria (Group A). And from the Pearson Correlation, it is clear that there is a signicant positive correlation between Atherogenic Index and Microalbuminuria as found in Group B patients. Endothelial dysfunction in the vascular wall has been proposed to play a pivotal role in the development and progression of subclinical atherosclerosis. The excretion of albumin into the urine is also due to a disturbance in the barrier function of endothelial glomerular cells (Podocytes). So, the pathogenesis is systemic endothelial dysfunction and is common for both Atherosclerosis and Albumin excretion in urine. So the two parameters can be related. Hence, Microalbuminuria can be used as an independent biochemical marker for early prediction of Cardiovascular risk factors and for primary prevention from Cardiovascular diseases. Albuminuria being a modiable risk marker and studies of secondary prevention have shown that blood pressure– lowering drugs effectively reduce the albumin excretion rate, ACE inhibitors seem to be particularly effective. The current observation may lead to new therapeutic strategies in the prevention of CV disease. Albumin excretion levels may represent the primary marker for success of such therapies. CONCLUSION: Microalbuminuria can be used as an independent marker for early prediction of Cardiovascular complications and can be used as a screening procedure in all patients diagnosed with type 2 Diabetes mellitus. Periodic screening for microal buminuria could allow early identication of vascular disease and help stratify overall cardiovascular risk, especially in patients with risk factors such as Diabetes. A positive test for urinary albumin excretion could signify the need for an intensive multifactorial intervention strategy, including behavior modication and targeted pharmacotherapy, aimed at preventing further renal deterioration and improving the overall CVD risk factor prole. In our study, the measurement of urinary albumin excretion is based on a single early morning urine sample. 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Subinaydatta, Mrinal Pal, Comparison Between Different Methods Of Urine Collection For Estimation Of Albumin-Creatinine Ratio In Patients With Type-2 Diabetes Mellitus, Advances In Biological Chemistry, 2013, 3, 403-407. VOLUME-9, ISSUE-1, JANUARY-2020 • PRINT ISSN No. 2277 - 8160 • DOI : 10.36106/gjra 4 X GJRA - GLOBAL JOURNAL FOR RESEARCH ANALYSIS