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

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:

• diabetes mellitus
• atherosclerotic cardiovascular disease
• urinary albumin creatinine ratio
• cardiovascular mortality

Abbreviations

DM, Diabetes mellitus; uACR, urinary albumin creatinine ratio; ASCVD, Atherosclerotic cardiovascular disease; CVD, Cardiovascular disease; CAD, Coronary artery disease; HT, Hypertension; CKD, Chronic kidney disease; CHF, Congestive heart failure; AMI, Acute myocardial infarction; PCI, Percutaneous coronary intervention; LDLC, low-density lipoprotein cholesterol; HDLC, high-density lipoprotein cholesterol; ACEI/ARB, Angiotensin converting enzyme inhibitors or angiotensin receptor blocker; CI, Confidence interval.

Data Sharing Statement

The datasets used and/or analysed during the current study are available from the corresponding author on reasonable request.

Ethics Approval and Consent to Participate

The study protocol was approved by the Guangdong Provincial People’s Hospital ethics committee (No.GDREC2019-555H-2), all participating sites received institutional review board approval from their own ethics committees, and the study was performed according to the declaration of Helsinki. All the data used in this study were anonymized before its use. Since our study included retrospective cases, there was no additional intervention, and all patient information was desensitized, and no informed consent was required. The need of informed consent was waived by Guangdong Provincial People’s Hospital ethics committee (No.GDREC2019-555H-2).

Author Contributions

All authors made a significant contribution to the work reported in terms of the conception, study design, execution, acquisition of data, analysis and interpretation. They took part in drafting, revising or reviewing the article; gave final approval of the final manuscript to be published; agreed on the journal to which the article has been submitted; and agreed to be accountable for all aspects of the work.

Disclosure

The authors report no conflicts of interest in this work.

Additional information

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.