Silent cerebral infarction in patients with type 2 diabetic nephropathy. Effects of antiplatelet drug dilazep dihydrochloride

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Abstract
Background To determine whether diabetic nephropathy is a risk factor for silent cerebral infarction and whether antiplatelet drug dilazep dihydrochloride decreases the occurrence of silent cerebral infarction in type 2 diabetes patients with microalbuminuria. Methods Two hundred four type 2 diabetes patients (124 men, 80 women; age, median 56 years, range 42–74 years) and 60 healthy age‐matched subjects (no diabetes, normal renal function) were recruited for brain magnetic resonance imaging. The diabetes patients included 40 without nephropathy (group A), 42 with microalbuminuria (20–200 µg/min) (group B), 44 with macroalbuminuria (>200 µg/min) and normal renal function (blood creatinine 132.7 µmol/L; mean creatinine 335.9 µmol/L) (group D) and 45 undergoing haemodialysis (duration; median 4 years, range 3–6 years) (group E). Results Silent cerebral infarction was found in 20, 29, 34, 45, 53 and 8% of group A, B, C, D, E and control patients respectively. The incidence of silent cerebral infarction was increased with diabetic nephropathy. Thirty group B patients with no silent cerebral infarction were divided into two groups: (B1) 15 treated with dilazep dihydrochloride and (B2) 15 not treated with dilazep dihydrochloride. Treatment continued for 24 months. The incidence of silent cerebral infarction was significantly lower in the dilazep‐treated patients (6.7%) than in the untreated patients (33.3%) (p < 0.01). Conclusions These data suggest that diabetic renal dysfunction increases the risk of silent cerebral infarction and that dilazep dihydrochloride prevents its onset in early type 2 diabetic nephropathy patients. Copyright © 2004 John Wiley & Sons, Ltd.