Higher urinary albumin-to-creatinine ratio within the normoalbuminuric range independently predicted a higher 6-year risk of major adverse cardiovascular events (adjusted HR 1.67) in adults with T2DM.
Cohort (n=420)
No
Does higher urinary albumin-to-creatinine ratio within the normoalbuminuric range predict major adverse cardiovascular events and coronary artery disease severity in adults with type 2 diabetes and preserved kidney function?
In adults with type 2 diabetes and preserved kidney function, higher urinary albumin-to-creatinine ratio even within the normal range (<30 mg/g) independently predicts greater coronary artery disease severity and 6-year MACE risk.
Effect estimate: HR 1.67 (95% CI 1.35-2.10)
p-value: p=<0.01
BACKGROUND: Urinary albumin excretion is an established marker of cardiovascular (CV) risk in people with type 2 diabetes mellitus (T2DM). However, its prognostic significance within the normoalbuminuric range ( 60 mL/min/1.73 m², UACR < 30 mg/g), treating sex differences as a co-primary objective. METHODS: We conducted a retrospective cohort study involving adults with T2DM who underwent diagnostic coronary angiography. Baseline associations between log-transformed UACR, CAD severity, CV risk factors, and inflammatory markers were evaluated using multivariable linear regression. MACE (defined as non-fatal myocardial infarction or unstable angina requiring urgent revascularization, stroke, or CV death) were recorded during 6-year of follow-up. Cox proportional hazards models, adjusted for age, sex, hypertension, smoking, BMI, lipid profile, hs-CRP, and ACEI/ARB use, were used to assess UACR-MACE associations. RESULTS: We included 420 adults (180 women, 42.9%) with a mean of age 65.3 ± 10.7 years and a median UACR 7.56 mg/g (IQR 4.12-15.5). Significant CAD was present in 310 participants (73.8%), and 78 experienced MACE during follow-up (35.5%). Higher UACR was independently associated with greater coronary stenosis (adjusted R² = 0.090, p < 0.001). Kaplan-Meier analysis showed a significantly higher incidence of MACE in the highest UACR tertile (log-rank p = 0.039). In multivariable Cox models adjusted for age, sex, hypertension, smoking, lipid profile, hs-CRP, SSI, and ACEI/ARB use, higher log-UACR independently predicted MACE (adjusted HR 1.67, 95% CI 1.35-2.10; p < 0.01). In sex-stratified Cox models, higher log-UACR predicted MACE in both sexes and remained independently associated in multivariable analyses (adjusted HR 1.67, 95% CI 1.35-2.10; p < 0.01). Associations were directionally stronger in women, who showed higher cumulative event rates across UACR tertiles, although the formal UACR × sex interaction did not reach statistical significance. CONCLUSIONS: Within the normoalbuminuric range, UACR is associated with greater CAD burden and higher 6-year MACE risk, with sex-specific differences. These findings suggest potential sex-related variation in the prognostic value of high-normal albuminuria, particularly among women, warranting validation in larger and more diverse cohorts.
Siverio-Morales et al. (Thu,) conducted a cohort in Type 2 diabetes mellitus with preserved kidney function and normoalbuminuria (n=420). Higher urinary albumin-to-creatinine ratio (log-UACR) vs. Lower urinary albumin-to-creatinine ratio was evaluated on Major adverse cardiovascular events (MACE) (HR 1.67, 95% CI 1.35-2.10, p=<0.01). Higher urinary albumin-to-creatinine ratio within the normoalbuminuric range independently predicted a higher 6-year risk of major adverse cardiovascular events (adjusted HR 1.67) in adults with T2DM.
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