Association Between Subclinical Albuminuria and Early Arterial Stiffness in Chinese Adults with Type 2 Diabetes

Background: While elevated microalbuminuria is closely associated with arterial stiffness, the relationship between high-normal albuminuria and arterial stiffness remains unclear among Chinese adults with type 2 diabetes. Objective: This study aimed to investigate the association between subclinical albuminuria and early arterial stiffness in a cohort of Chinese adults with T2DM, focusing on sex-specific differences and threshold effects. Methods: In this cross-sectional study, 1119 Chinese adults with type 2 diabetes and without overt kidney or cardiovascular disease were enrolled. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV). Participants were stratified by tertiles of the logarithmically transformed urinary albumin-to-creatinine ratio (lg-UACR). We employed correlation analysis to examine continuous relationships and multivariable logistic regression to assess the odds of high baPWV across lg-UACR tertiles. Sex-stratified and restricted cubic spline analyses were conducted to explore effect modification and nonlinearity. Results: Higher lg-UACR tertiles demonstrated a dose-dependent association with arterial stiffness risk in the overall cohort. Sex-stratified analysis revealed this association was statistically significant only in women. Among postmenopausal women, a threshold effect was observed at lg-UACR =1.1 (UACR =12.6 mg/g), beyond which the significant correlation between microalbuminuria and arterial stiffness was attenuated. Conclusion: Elevated UACR in normal range is associated with arterial stiffness risk in Chinese women with type 2 diabetes, but not in men. Among postmenopausal women, this link is significant only below a lg-UACR threshold of 1.1 and is abolished at or above this level. This critical threshold effect, modulated by menopause, suggests sex-specific UACR criteria for vascular risk assessment.