Albuminuria predicts adverse outcomes in T2D without CVD

  • Fangel MV & al.
  • Am J Med
  • 20 Mar 2020

  • curated by Miriam Tucker
  • Clinical Essentials
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Takeaway

  • Micro- and macroalbuminuria are associated with higher risk for ischemic stroke, myocardial infarction (MI), and all-cause mortality among patients with type 2 diabetes (T2D) without overt atherosclerotic cardiovascular disease (CVD).

Why this matters

  • For T2D patients without overt atherosclerotic CVD, CVD risk stratification is recommended to guide primary prevention strategies.

Study design

  • Danish nationwide registry data for 69,532 patients with T2D without CVD, including 58,361 with normoalbuminuria, 7977 with microalbuminuria, and 3194 with macroalbuminuria.
  • Funding: None.

Key results

  • During 5-year follow-up, 1.4% had ischemic stroke, 1.2% had MI, and 5.4% died.
  • Incidence/100 person-years increased across albuminuria levels:
    • Ischemic stroke: 
      • Normoalbuminuria: 0.39. 
      • Microalbuminuria: 0.59.
      • Macroalbuminuria: 0.90. 
    • MI: 
      • Normoalbuminuria: 0.31.
      • Microalbuminuria: 0.49.
      • Macroalbuminuria: 0.83. 
    • All-cause mortality: 
      • Normoalbuminuria: 1.40. 
      • Microalbuminuria: 2.62.
      • Macroalbuminuria: 3.48.
  • For microalbuminuria vs normoalbuminuria groups after adjustment for CVD risk factors, risks (HRs; 95% CI) were:
    • Ischemic stroke: 1.28 (1.07-1.52). 
    • MI: 1.34 (1.10-1.62). 
    • All-cause mortality: 1.48 (1.36-1.61).
  • For macroalbuminuria vs normoalbuminuria (HRs; 95% CI), risks were:
    • Ischemic stroke: 1.81 (1.46-2.23).
    • MI: 1.99 (1.59-2.48). 
    • All-cause mortality: 1.83 (1.64-2.04).
  • Similar results found after adjustment for medication status.

Limitations

  • Only primary diagnoses used for outcomes.
  • Could not classify albuminuria by recommended 2-3 specimens within 3-6 months.