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Background The aim of this study was to examine the relationship of albuminuria to cardiovascular disease outcomes in diabetic patients undergoing treatment for stable coronary artery disease. Methods and results We analyzed data from 2176 participants of the Bypass Angioplasty Revascularization Investigation in type‐2 diabetes (BARI‐2D) trial, a randomized clinical trial comparing Percutaneous coronary intervention/Coronary artery bypass grafting (PCI/CABG) to medical therapy for people with diabetes. The population was stratified by baseline spot urine albumin–creatinine ratio (uACR) into normal (uACR <10 mg/g), mildly (uACR ≥10 mg/g < 30 mg/g), moderately (uACR ≥30 mg/g < 300 mg/g) and severely increased (uACR ≥300 mg/g) groups, and outcomes compared between groups. Death, myocardial infarction (MI) and/or stroke were experienced by 489 patients at a mean follow‐up of 4.3 ± 1.5 years. Compared with normal uACR, mildly increased uACR was associated with a 1.4 times (P = 0.042) increase in all‐cause mortality. Additionally, nonwhites with type‐II diabetes and stable coronary artery disease who had mildly increased albuminuria had a Hazard ratio (HR) of 3.3 times (P = 0.028) for cardiovascular death, 3.1 times for (P = 0.002) all‐cause mortality, and two times for (P = 0.015) MI during follow‐up. Conclusions Mildly increased albuminuria is a significant predictor of all‐cause mortality in those with type‐II diabetes mellitus and stable coronary artery disease, as well as for cardiovascular events those who are nonwhites.

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