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Albuminuria significantly predicts cardiovascular events in patients with type 2 diabetes independently from the baseline coronary artery state

Session Poster Session 6

Speaker Christoph Saely

Event : ESC Congress 2013

  • Topic : preventive cardiology
  • Sub-topic : Risk Factors and Prevention – Cardiovascular Risk Assessment
  • Session type : Poster Session

Authors : P Rein (Fedlkirch,AT), CH Saely (Fedlkirch,AT), D Zanolin (Feldkirch,AT), A Vonbank (Triesen,LI), H Drexel (Philadelphia,US)

P. Rein1 , C.H. Saely1 , D. Zanolin2 , A. Vonbank3 , H. Drexel4 , 1Academic Teaching Hospital, Department of Internal Medicine - Fedlkirch - Austria , 2VIVIT Institute - Feldkirch - Austria , 3Private University of the Principality of Liechtenstein - Triesen - Liechtenstein , 4Drexel University College of Medicine - Philadelphia - United States of America ,

European Heart Journal ( 2013 ) 34 ( Abstract Supplement ), 963-964

Purpose: Albuminuria is an important indicator of cardiovascular risk. We have recently shown that it is also associated with angiographically determined coronary artery disease (CAD). Whether albuminuria predicts cardiovascular events independently of the baseline coronary artery state in patients with type 2 diabetes (T2DM) has not been investigated yet.

Methods: We measured urinary albumin and creatinine concentrations in 211 consecutive patients with T2DM undergoing coronary angiography for the evaluation of suspected or established stable CAD. Albuminuria was defined as a urinary albumin to creatinine ratio (ACR) of 30 μg/mg or greater. Prospectively, we recorded vascular events over 3.2±1.4 years.

Results: During follow up, 24.6% of our patients suffered cardiovascular events. The cardiovascular event rate was significantly higher in patients with albuminuria (n=85) than in those with normoalbuminuria (35.3 vs. 17.5%; p=0.003). Cox regression analysis adjusting for age, gender, BMI, smoking, systolic and diastolic blood pressure, LDL cholesterol, HDL cholesterol, eGFR, and use of ace inhibitors/angiotensin II antagonists confirmed that albuminuria significantly predicted cardiovascular events independently from conventional risk factors (adjusted HR 1.96 [1.11-3.46]; p=0.021). Further adjustment for the angiographically determined presence of CAD at baseline did not significantly attenuate the predictive power of the ACR (HR 1.84 [1.04-3.27]; p=0.037). Similar results were obtained when the ACR was entered into the final regression model as a continuous variable (standardized adjusted HR 1.30 [1.02-1.65]; p=0.037).

Conclusions: Albuminuria significantly predicts cardiovascular events in patients with T2DM independently of established cardiovascular risk factors and of the baseline coronary artery state.

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