Even Normal Range Albuminuria Ups Cardiovascular Risk

Increased risk seen in type 2 diabetes; link lost with ACE inhibitors

FRIDAY, Aug. 31 (HealthDay News) -- For patients with type 2 diabetes with normal albumin levels, any degree of albuminuria is associated with an increased risk of cardiovascular events, according to a study published online Aug. 30 in the Journal of the American Society of Nephrology.

To examine the association between albuminuria and cardiovascular events, Piero Ruggenenti, M.D., of the Mario Negri Institute for Pharmacological Research in Bergamo, Italy, and colleagues conducted a study involving 1,208 patients with type 2 diabetes who had hypertension but normal albumin levels and who may have received angiotensin-converting enzyme (ACE) inhibitor therapy as part of the Bergamo Nephrologic Diabetes Complication Trial.

After a median follow-up of 9.2 years, the researchers found that 15.6 percent of patients experienced a main outcome event (fatal/non-fatal myocardial infarction; stroke; coronary, carotid, or peripheral artery revascularization; or hospitalization for heart failure), including 24 fatal events. Albuminuria was an independent predictor of events (hazard ratio [HR], 1.05; 95 percent confidence interval [CI], 1.02 to 1.08). There was a continuous non-linear relationship observed between albuminuria and events, with no evidence of a threshold. Even levels of 1 to 2 µg/min were significantly associated with an increased risk of events compared with albuminuria less than 1 µg/min (HR, 1.04; 95 percent CI, 1.02 to 1.07). In the subgroup of patients who took ACE inhibitors from the start of the study and throughout the follow-up period, no association between albuminuria and cardiovascular risk was noted.

"Among normoalbuminuric patients with type 2 diabetes, any degree of measurable albuminuria bears significant cardiovascular risk," the authors write. "The association with risk is continuous but is lost with early ACE inhibitor therapy."

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