Effect of Urinary Albumin Creatinine Ratio on Cardiovascular Morbidity and Mortality in Diabetes Patients with Atherosclerotic Disease

Diabetes Metab Syndr Obes. 2023 Mar 17:16:819-828. doi: 10.2147/DMSO.S400970. eCollection 2023.

Authors

Fei Gao^#¹, Yang Zhou^#^{2

3}, Xiaoming Yan^#⁴, Haozhang Huang^{2

3

5}, Guoxiao Liang^{2

3}, Yongyi Xie⁶, Qijiong Zhu⁷, Ziming Chen⁸, Bo Wang^{2

3}, Huanqiang Li^{2

3}, Ziling Mai^{2

3

9}, Ming Ying^{2

3}, Jin Liu^{2

3}, Shiqun Chen^{2

3}, Jiyan Chen^{2

3

10}

Affiliations

¹ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People's Republic of China.
² Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
³ Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
⁴ Department of Information Technology, Guangdong Provincial People's Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People's Republic of China.
⁵ The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People's Republic of China.
⁶ School of Pharmacy, Guangdong Medical University, Dongguan, People's Republic of China.
⁷ School of Public Health, Guangdong Medical University, Dongguan, People's Republic of China.
⁸ School of Foreign Studies, Southern Medical University, Guangzhou, People's Republic of China.
⁹ School of Biology and Biological Engineering, South China University of Technology, Guangzhou, People's Republic of China.
¹⁰ Guangdong Provincial People's Hospital, School of Medicine, South China University of Technology, Guangzhou, People's Republic of China.

^# Contributed equally.

Abstract

Background: Diabetes mellitus (DM) patients with increased urinary albumin creatinine ratio (uACR) have higher risk of mortality, while it is unclear in DM patients with atherosclerotic cardiovascular disease (ASCVD).

Methods: We analysed 2832 DM patients with ASCVD in this multi-center registry cohort study Cardiorenal ImprovemeNt II (CIN-II) in 5 Chinese tertiary hospitals from 2007 to 2020. Patients were divided into 3 groups according to their uACR level (normal group: uACR <30mg/g, moderately increased group: 30mg/g≤ uACR <300mg/g, severely increased group: 300mg/g≤ uACR). The main outcome of the study was cardiovascular mortality and all-cause mortality.

Results: During a median follow-up of 2.1 years, among 2832 patients (mean age: 63.3 ± 9.9 years, 29.1% women), 434 patients (15.3%) had moderately increased uACR, and 203 patients (7.2%) had severely increased uACR. Compared to patients in normal group, patients had higher cardiovascular mortality in moderately increased group and severely increased group (2.5% vs 9.9% vs 16.7%, P < 0.001), as well as all-cause mortality. After adjusting confounders, the risk of cardiovascular mortality remained higher in moderately increased group (adjusted hazard ratio [aHR]: 3.13; 95% confidence interval [CI]: 2.04-4.81) and severely increased group (aHR: 4.54; 95% CI: 2.58-8.01) than in normal group, as well as all-cause mortality.

Conclusion: In our study, we found nearly a quarter of DM patients with ASCVD had increased uACR, and they have over 2- or 3-fold risk of cardiovascular mortality than those with normal uACR. UACR is a helpful indicator for risk stratification and treatment target for DM patients with ASCVD.

Keywords: atherosclerotic cardiovascular disease; cardiovascular mortality; diabetes mellitus; urinary albumin creatinine ratio.

© 2023 Gao et al.

Grants and funding

This work was supported by grants from Guangdong Provincial science and technology project (2020B1111170011); Guangdong Provincial science and technology project (KJ022021049); Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention (No.Y0120220151). The work was not funded by any industry sponsors.