Low-grade albuminuria is associated with early but not late carotid atherosclerotic lesions in community-based patients with type 2 diabetes

Abstract

BackgroundLow-grade albuminuria is associated with cardiovascular risk factors and mortality. Our aim was to investigate the association between low-grade albuminuria and carotid atherosclerotic lesions in community-based patients with type 2 diabetes.MethodsA cross-sectional study was performed in 475 community-based patients with type 2 diabetes (190 males and 285 females) with normal urinary albumin-to-creatinine ratios (UACR) (< 3.5 mg/mmol) from Shanghai, China. The subjects were stratified into tertiles based on UACR levels (the lowest tertile was UACR ≤ 1.19 mg/mmol, and the highest tertile was UACR ≥ 2 mg/mmol). Carotid intima-media thickness (CIMT), carotid atherosclerotic plaque formation and stenosis were assessed and compared among the three groups based on ultrasonography. The urinary albumin excretion rate was determined as the mean of the values obtained from three separate early morning urine samples.ResultsCompared with the subjects with UACR in the lowest tertile, the subjects with UACR in the middle and highest tertiles had greater CIMT values (0.88 ± 0.35 mm, 0.99 ± 0.43 mm and 1.04 ± 0.35 mm, respectively; all p < 0.05) and a higher prevalence of carotid atherosclerotic plaques (25.3%, 39.0% and 46.2%, respectively; all p < 0.05) after adjusting for sex and age. Fully adjusted multiple linear regression and logistic regression analyses revealed that UACR tertiles were significantly associated with elevated CIMT (p = 0.007) and that, compared with the subjects in the first tertile of UACR, those in the second and third tertiles had 1.878- and 2.028-fold risk of carotid plaques, respectively. However, there was no statistical association between UACR tertile and the prevalence of carotid stenosis.ConclusionsHigher UACR within the normal range was independently associated with early but not late carotid atherosclerotic lesions in community-based patients with type 2 diabetes. Low-grade albuminuria contributes to the risk of carotid atherosclerosis and may be used as an early marker for the detection of atherosclerosis in patients with type 2 diabetes.

High normal albuminuria is associated with arterial stiffness and carotid atherosclerosis in Korean patients with type 2 diabetes

“…However, our study provides novel information that high normal albuminuria is significantly associated with subclinical atherosclerosis independent of the presence of DMR. Moreover, our results showed significant associations between low-grade albuminuria and both early and late carotid atherosclerosis, inconsistent with the findings of Li et al [9]. The discrepancy might be related to the much lower prevalence of carotid stenosis in the study of Li et al (<4%; carotid stenosis defined as any degree of narrowing of the carotid arteries by carotid plaque) compared to that in the present study (19.6%; carotid stenosis defined as 50% or greater of luminal narrowing), raising the possibility of an underpowered calculation in Li et al…”

“…With regards to atherosclerotic markers, several crosssectional studies demonstrated that a high ACR within the normal range was independently associated with increased carotid intima-media thickness and/or carotid plaques in various populations [6e8] and patients with T2DM [9,10]. However, previous studies rarely included the presence of DMR, a major confounding variable in the analysis.…”

Serum uric acid levels are associated with hypertension and metabolic syndrome but not atherosclerosis in Chinese inpatients with type 2 diabetes

“…Both the carotid and lower limb arteries were subjected to Doppler ultrasound examinations that include measurements of IMT, atherosclerotic plaque and stenosis as described in previous studies in detail [ 11 – 15 ]. The definitions of CIMT, FIMT, carotid and lower limb atherosclerotic plaques and stenosis had also been described in detail in our previous studies [ 11 – 14 , 16 ]. In the present study, atherosclerotic plaque and stenosis were defined as the presence of either carotid or lower limb arterial atherosclerotic plaques and stenoses, respectively.…”

High‐normal urinary albumin‐to‐creatinine ratio is independently associated with metabolic syndrome in Chinese patients with type 2 diabetes mellitus: A cross‐sectional community‐based study

“…The physical and laboratory examinations used in the present study have been described previously 13 . The glomerular filtration rate (eGFR) was assessed by the simplified Modification of Diet in Renal Disease formula: 186.3 9 (serum creatinine) -1.154 9 (age) -0.203 (90.742 if female) 14 .…”