Albuminuria and Risk of Cardiovascular Events and Mortality in a General Population of Patients with Type 2 Diabetes Without Cardiovascular Disease: A Danish Cohort Study

被引:22
|
作者
Fangel, Mia Vicki [1 ]
Nielsen, Peter Bronnum [2 ,3 ]
Kristensen, Jette Kolding [1 ]
Larsen, Torben Bjerregaard [2 ,3 ]
Overvad, Thure Filskov [2 ,4 ]
Lip, Gregory Y. H. [2 ,5 ,6 ]
Jensen, Martin Bach [1 ]
机构
[1] Aalborg Univ, Ctr Gen Practice, Fyrkildevej 7,1, DK-9220 Aalborg, Denmark
[2] Aalborg Univ, Fac Hlth, Dept Clin Med, Aalborg Thrombosis Res Unit, Aalborg, Denmark
[3] Aalborg Univ Hosp, Dept Cardiol, Atrial Fibrillat Study Grp, Aalborg, Denmark
[4] North Denmark Reg Hosp, Dept Med, Hjorring, Denmark
[5] Univ Liverpool, Liverpool Ctr Cardiovasc Sci, Liverpool, Merseyside, England
[6] Liverpool Heart & Chest Hosp, Liverpool, Merseyside, England
来源
AMERICAN JOURNAL OF MEDICINE | 2020年 / 133卷 / 06期
关键词
Albuminuria; Cardiovascular disease; Diabetes; Myocardial infarction; Stroke; GLOMERULAR-FILTRATION-RATE; COLLABORATIVE METAANALYSIS; VASCULAR-DISEASE; RENAL-FUNCTION; MELLITUS; MICROALBUMINURIA; OUTCOMES; EXCRETION; STROKE; IMPACT;
D O I
10.1016/j.amjmed.2019.10.042
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
BACKGROUND: Albuminuria level is associated with cardiovascular events and mortality in patients with diabetes. However, little is known about the association between albuminuria level in diabetes patients without overt cardiovascular disease. We aimed to examine the association between albuminuria level and the risk of ischemic stroke, myocardial infarction, and all-cause mortality in patients with type 2 diabetes without overt cardiovascular disease. METHODS: We linked Danish nationwide registries to identify patients with type 2 diabetes without cardio- vascular disease from May 2005 through June 2015. Patients were followed for the outcomes ischemic stroke, myocardial infarction, and all-cause mortality until December 31, 2015. Albuminuria level was based on 2 consecutive measurements of the urinary albumin excretion rate or albumin-to-creatinine ratio. Associations between albuminuria level and incidence of cardiovascular disease and mortality were evalu- ated with Cox proportional hazard regression. RESULTS: The study population consisted of 69,532 patients with type 2 diabetes without cardiovascular disease. When comparing patients with microalbuminuria to patients with normoalbuminuria, in an analysis adjusted for cardiovascular risk factors, we found hazard ratios of 1.28 (95% confidence interval [CI], 1.07-1.52), 1.34 (95% CI, 1.10-1.62), and 1.48 (95% CI, 1.36-1.61) for ischemic stroke, myocardial infarction, and all-cause mortality, respectively. For macroalbuminuria, the hazard ratios were 1.81 (95% CI, 1.46-2.23), 1.99 (95% CI, 1.59-2.48), and 1.83 (95% CI, 1.64-2.04). Similar results were found after adjusting for concomitant medication. CONCLUSIONS: This study showed thatalbuminurialevel is associated withhigherriskofincident ischemic stroke, myocardial infarction, and all-cause mortality in Type 2 diabetes patients without overt cardiovascular disease. (C) 2020 Elsevier Inc. All rights reserved.
引用
收藏
页码:E269 / E279
页数:11
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