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Microalbuminuria in type 2 diabetes: an independent predictor of cardiovascular mortality
J Beilin1, K G Stanton, V J McCann
1Department of Endocrinology and Diabetes, Royal Perth Hospital, WA.
Background:
Microalbuminuria has been shown to be associated with cardiovascular mortality in type 2 diabetic subjects. It is unclear to what extent this is due to the increased prevalence of other cardiac risk factors.
Aims:
To examine the relationship of urine albumin excretion to cardiovascular mortality and to determine its status as an independent risk factor.
Methods:
In a prospective longitudinal study from 1986-1993 we followed 666 type 2 diabetic subjects from a diabetes outpatient service. Cardiovascular risk factors including urine albumin concentration were measured at study entry. Cox proportional hazards regression was used to determine risk factors for mortality. The hazard ratios of microalbuminuria and macroalbuminuria for all cause, cardiovascular and coronary heart disease mortality were determined after accounting for other cardiac risk factors including blood pressure, glycated haemoglobin, total cholesterol, HDL cholesterol, triglycerides, urea, smoking, body mass index, patient age and disease duration.
Results:
The prevalence of urine albumin of 30-300 mg/L at study entry was 31.7%. A total of 167 deaths occurred (80 from cardiovascular disease). Mortality hazard ratios in subjects with urine albumin of 30-300 mg/L as compared to < 30 mg/L, adjusted for age, sex and other cardiovascular risk factors were 1.77 (95% CI 1.22-2.57, p = 0.002) for all causes, 2.34 (95% CI 1.38-3.99, p = 0.002) for cardiovascular and 1.78 (95% CI 0.97-3.26, p = 0.061) for coronary heart disease (CHD) mortality. Other factors significantly associated with cardiovascular mortality included diastolic blood pressure, HDL cholesterol and glycated haemoglobin. Total cholesterol and log triglyceride were significantly associated with CHD mortality. Disease duration, age at diagnosis, smoking and body mass index were not related to cardiovascular or CHD mortality.
Conclusions:
We confirm microalbuminuria as an independent predictor of mortality in type 2 diabetes despite its association with a number of conventional cardiovascular risk factors.
Insights
Microalbuminuria is an independent predictor of mortality in type 2 diabetes. This study confirms that elevated urine albumin levels significantly increase the risk of cardiovascular death, even after accounting for other risk factors.
Area of Science:
- Nephrology
- Cardiology
- Endocrinology
Background:
- Microalbuminuria is linked to cardiovascular mortality in type 2 diabetes.
- The extent to which other cardiac risk factors contribute to this association is unclear.
Purpose of the Study:
- To examine the relationship between urine albumin excretion and cardiovascular mortality.
- To determine if microalbuminuria is an independent risk factor for mortality in type 2 diabetes.
Main Methods:
- Prospective longitudinal study of 666 type 2 diabetic subjects (1986-1993).
- Measured urine albumin concentration and other cardiovascular risk factors at baseline.
- Used Cox proportional hazards regression to analyze mortality risk, adjusting for multiple conventional risk factors.
Main Results:
- 31.7% of subjects had microalbuminuria (urine albumin 30-300 mg/L).
- Microalbuminuria was associated with a 1.77-fold increased risk of all-cause mortality and a 2.34-fold increased risk of cardiovascular mortality.
- Diastolic blood pressure, HDL cholesterol, and glycated hemoglobin were also significant predictors of cardiovascular mortality.
Conclusions:
- Microalbuminuria is confirmed as an independent predictor of mortality in type 2 diabetes.
- This association persists despite the presence of conventional cardiovascular risk factors.
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