Usefulness of Albuminuria as Predictor for Coronary Artery Stenosis, Regardless of Estimated Glomerular Filtration Rate, in Patients With Type 2 Diabetes Mellitus

Son, Jang‐Won; Jang, Eun-Hee; Kim, Meekyoung; Kim, Hyo-Lim; Baek, Kwang‐Hyun; Song, Ki‐Ho; Yoo, Soon Jib; Yoon, Kun‐Ho; Cha, Bong-Yun; Lee, Kwang-Woo; Son, Ho‐Young; Kwon, Hyuk Sang

doi:10.1016/j.amjcard.2012.07.006

Cited by 9 publications

(7 citation statements)

References 29 publications

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“…Recent epidemiological studies have demonstrated that chronic kidney disease (CKD), defined as an estimated glomerular filtration rate (eGFR) <60 ml/min, is an independent risk factor for atherosclerotic disease [ 17 ] and for the presence of carotid plaques [ 18 ]. In T2D patients, a high prevalence of low eGFR without associated albuminuria has been reported and described to be associated with atherosclerosis of peripheral arteries, independently of albuminuria, [ 19 ] and with cIMT in several [ 20 ], but not all, studies [ 21 , 22 ].…”

Section: Introductionmentioning

confidence: 99%

Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy

Alonso¹,

Traveset

Rubinat

et al. 2015

Cardiovasc Diabetol

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BackgroundCardiovascular disease (CVD) is the leading cause of mortality among subjects with type 2 diabetes (T2D), and diabetic retinopathy (DR) has been associated with an increased risk for CVD. The present study was designed to test the concept that T2D patients with DR, but without previous cardiovascular (CV) events and with normal renal function, have an increased atherosclerotic burden compared with patients without DR.MethodsA cross-sectional study was performed using patients with normal renal function (estimated glomerular filtration rate (eGFR) >60 ml/min) and without previous CV events. A total of 312 patients (men, 51%; mean age, 57 yrs; age range 40–75 yrs) were included in the study; 153 (49%) of the patients had DR. B-mode carotid ultrasound imaging was performed for all of the study subjects to measure the carotid intima-media thickness (cIMT) and carotid plaques in the common carotid artery (CCA), bifurcation and internal carotid artery (ICA).ResultsThe percentage of carotid plaques in T2D patients with DR was higher than in T2D patients without DR (68% vs. 52.2%, p = 0.0045), and patients with DR had a higher prevalence of ≥2 carotid plaques (44.4% vs. 21.4%; p < 0.0001). No differences were observed in the cIMT measured at different carotid regions between the patients with or without DR. Using multivariate logistic regression (adjustment for major risk factors for atherosclerosis), DR was independently associated with mean-internal cIMT (p = 0.0176), with the presence of carotid plaques (p = 0.0366) and with carotid plaque burden (≥2 plaques; p < 0.0001).ConclusionsThe present study shows that DR in T2D patients without CVD and with normal renal function is associated with a higher atherosclerotic burden (presence and number of plaques) in the carotid arteries. These patients may be at a higher risk for future CV events; therefore, an ultrasound examination of the carotid arteries should be considered in patients with DR for more careful and individualised CV assessment and follow-up.

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Section: Introductionmentioning

confidence: 99%

Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy

Alonso¹,

Traveset

Rubinat

et al. 2015

Cardiovasc Diabetol

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“…However, repeated measurement of these parameters or direct measurement of eGFR is both time consuming and costly and is therefore not feasible for nationwide health examination studies. Additionally, single-point measurement of ACR has been used to predict increased CVD risk [38] , [39] . Second, in this study, the proportion of subjects taking antihypertensive agents was 14.9% (95% CI, 13.7–16.3).…”

Section: Discussionmentioning

confidence: 99%

Prevalence of and Factors Associated with Albuminuria in the Korean Adult Population: The 2011 Korea National Health and Nutrition Examination Survey

et al. 2013

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BackgroundMicroalbuminuria is associated with increased risk of renal disease and cardiovascular diseases even in non-diabetic subjects. High incidence rates of microalbuminuria have been found in a number of population-based studies. However, the prevalence and risk factors associated with microalbuminuria in the general population in Korea are unclear.ObjectivesThe present study was performed to estimate the prevalence of microalbuminuria and investigate the associated risk factors in the general adult population using the Fifth Korea National Health and Nutrition Examination Survey (KNHANES V-2) data from 2011.MethodsA total of 5,202 participants (mean age, 45.6 years; men, 2,337; women, 2,865) were included in the analysis. Microalbuminuria was evaluated in participants of KNHANES V-2 based on the urine albumin–creatinine ratio. Estimated glomerular filtration rate was calculated using the Modification of Diet in Renal Disease study equation.ResultsThe weighted prevalence of microalbuminuria was 5.2% (95% CI, 4.4–6.1) in the general population. The prevalence of albuminuria is increased with age. After adjustment for age and sex, the presence of albuminuria was associated with increased waist circumference, systolic and diastolic blood pressure, aspartate aminotransferase, triglyceride, fasting plasma glucose, and the presence of hypertension and diabetes. In logistic regression analyses, older age, female sex, diabetes, hypertension, and serum aspartate aminotransferase were independently associated with the presence of albuminuria.ConclusionThe prevalence of microalbuminuria was found to be 5.2%, and conventional risk factors for cardiovascular diseases are closely related to the presence of microalbuminuria in Korea. Microalbuminuria may be a useful marker to identify individuals with increased risk of cardiovascular disease.

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“…An increased urine albumin-to-creatinine ratio (UACR) is found to predict the risk of cardiovascular events and major PAD in T2DM patients [ 38 – 40 ]. Likewise, several trials have shown that low eGFR is also associated with an increased risk of developing macrovascular diseases in patients with diabetes [ 39 , 41 , 42 ]. However, there are few studies exploring the associations of albuminuria and decreased eGFR with the development of atherosclerosis in T2DM subjects [ 17 , 22 , 27 , 29 – 31 ].…”

Section: Discussionmentioning

confidence: 99%

Albuminuria but not low eGFR is closely associated with atherosclerosis in patients with type 2 diabetes: an observational study

Wang

Zhang

et al. 2022

Diabetol Metab Syndr

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Background There is still controversy regarding the associations of urinary albumin excretion (UAE) and estimated glomerular filtration rate (eGFR) with atherosclerosis in patients with type 2 diabetes mellitus (T2DM). Therefore, it is necessary to explore the correlation between them in T2DM patients. Methods We conducted a survey involving 2565 T2DM patients from a single center. The study cohort was classified into three groups based on the levels of albuminuria: normal UAE (UAE < 30 mg/24 h), moderate UAE (UAE between 30 and 299 mg/24 h) and high UAE (UAE ≥ 300 mg/24 h). Additionally, the patients were divided into three separate groups according to eGFR levels, including low eGFR (eGFR < 60 ml/min/1.73 m2), intermediate eGFR (eGFR 60–89 ml/min/1.73 m2) and normal eGFR (eGFR ≥ 90 ml/min/1.73 m2) groups. Atherosclerotic lesions were compared among the three UAE and eGFR groups. Regression analyses were used to assess the associations of atherosclerotic lesions with UAE and eGFR in T2DM. Results After controlling for age, sex and diabetes duration, the prevalence of atherosclerotic plaque and stenosis were significantly increased from the normal to high UAE groups (plaque: 72.2%, 78.6% and 87.3%, respectively, p = 0.016 for trend; stenosis: 14.0%, 25.5% and 37.3%, respectively, p < 0.001 for trend). Likewise, the values of carotid intima-media thickness (CIMT) and femoral intima-media thickness (FIMT) were also obviously increased from the normal to high UAE groups (CIMT: p < 0.001 for trend; FIMT: p = 0.001 for trend). Conversely, only the FIMT value was clearly increased from the low to normal eGFR groups (p = 0.001 for trend). Fully adjusted regression analyses revealed that UAE was closely associated with the presence of atherosclerotic plaque (OR 1.20, 95% CI 1.03–1.40, p = 0.020) and stenosis (OR 1.17, 95% CI 1.01–1.35, p = 0.036), and with the values of CIMT (β 0.05, 95% CI 0.01–0.10, p = 0.029) and FIMT (β 0.07, 95% CI 0.03–0.11, p = 0.001) in T2DM patients. However, there was no significant association between eGFR levels and atherosclerotic lesions in T2DM after adjustment for multiple confounding factors. Conclusions Overall, albuminuria rather than low eGFR is closely associated with atherosclerotic lesions in T2DM patients. Albuminuria is an independent risk factor for carotid and femoral atherosclerotic lesions in T2DM. Therefore, albuminuria may be a potential early marker to predict the development of atherosclerosis in patients with T2DM.

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Usefulness of Albuminuria as Predictor for Coronary Artery Stenosis, Regardless of Estimated Glomerular Filtration Rate, in Patients With Type 2 Diabetes Mellitus

Cited by 9 publications

References 29 publications

Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy

Type 2 diabetes-associated carotid plaque burden is increased in patients with retinopathy compared to those without retinopathy

Prevalence of and Factors Associated with Albuminuria in the Korean Adult Population: The 2011 Korea National Health and Nutrition Examination Survey

Albuminuria but not low eGFR is closely associated with atherosclerosis in patients with type 2 diabetes: an observational study

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