Albumin excretion and vascular deaths in NIDDM

Abstract

Non-insulin-dependent diabetes mellitus (NIDDM) is associated with premature mortality, generally thought to be exaggerated in patients with microalbuminuria. This prospective 8-year follow-up study aimed to determine outcome, mortality and cause of death in NIDDM patients with abnormal urinary albumin excretion compared to those with normal albumin excretion. We recruited 153 NIDDM patients with abnormal urinary albumin excretion and 153 control subjects with albumin excretion within the normal non-diabetic range, matched for age, sex and duration of diabetes, from three University hospital diabetic clinics in Newcastle upon Tyne. The outcome measures were status at follow-up, mortality and cause of death. Subjects with abnormal albumin excretion had a significantly higher 8-year mortality than matched control subjects (Odds Ratio 1.47, p = 0.02; 108 vs 66 per 1000 person years follow-up, p < 0.001). This difference was seen at all levels of abnormal albumin excretion, from just outside the normal range (10.6-29.9 microgram/min: 104 vs 61 per 1000 person years follow-up, p < 0.001) to more conventional definitions of microalbuminuria (> or = 30 micrograms/min: 111 vs 71 per 1000 person years follow-up, p < 0.01). Those with abnormal albumin excretion had an excess of vascular deaths compared to matched control subjects (Odds Ratio 1.70, p = 0.009), again at different levels of albumin excretion (10.6-29.9 micrograms/min p < 0.01, 30-150 micrograms/min p < 0.05). On multivariate analysis, age, initial ischaemic heart disease and initial albumin excretion rates were independent predictors of death from all causes.(ABSTRACT TRUNCATED AT 250 WORDS)

Very Low Levels of Microalbuminuria Are Associated With Increased Risk of Coronary Heart Disease and Death Independently of Renal Function, Hypertension, and Diabetes

“…8,32,33 This definition is of limited clinical relevance as a cardiovascular risk factor in the general population. First, Ͻ3% of the healthy population has urinary albumin excretion in this range.…”

An insulin-like growth factor-I gene polymorphism modifies the risk of microalbuminuria in subjects with an abnormal glucose tolerance

“…In subjects with type 2 diabetes MA is generally considered a stronger predictor of cardiovascular disease than it is of the risk of end-stage renal failure (34). Type 2 diabetes patients with MA are at an increased risk of cardiovascular death compared with patients with normal albuminuria (35,36). In addition, in non-diabetic subjects, MA is even considered an independent risk factor to developing cardiovascular disease (3,32).…”

Microalbuminuria and its relation to cardiovascular disease and risk factors. A population-based study of 1254 hypertensive individuals

“…2 A similar impact of microease and risk factors, renal function, and use of albuminuria is well established among diabetic indiblood pressure (BP) lowering agents in a large, repviduals, [3][4][5][6][7][8][9][10][11][12][13] and seems also to be valid in the entire resentative population of 1254 hypertensive indinon-diabetic, normotensive background popuviduals. lation.…”