Albuminuria is associated with an increased risk for ischemic stroke, myocardial infarction, and death in patients with type 2 diabetes mellitus and no known atherosclerotic cardiovascular disease, new study findings suggest.

“Using albuminuria status in combination with other well-known cardiovascular risk markers may provide the basis for clinically useful cardiovascular risk assessment,” Mia Vicki Fangel, PhD, of Aalborg University in Fyrkildevej, Denmark, and colleagues concluded in a paper published in the American Journal of Medicine.

Using Danish national registries, Dr Fangel and her colleagues identified 69,532 patients with type 2 diabetes (mean age 63 years; 55% male) who were free of atherosclerotic cardiovascular disease. Patients with microalbuminuria (urinary albumin-to-creatinine ratio [UACR] of 30 to 299 mg/g or urinary albumin excretion rate [UAE] of 30-299 mg/d) had significant 28%, 34%, and 48% increased risks for ischemic stroke, myocardial infarction, and all-cause mortality, respectively, after adjusting for cardiovascular risk factors compared with those who had normoalbuminuria.

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Patients with macroalbuminuria (UACR of 300 mg/g or higher or UAE of 300 mg/d or higher) had significant 81%, 99%, and 83% increased risks, respectively, the investigators reported.

More patients with elevated albuminuria had atrial fibrillation and/or heart failure at baseline, and they were more likely to be taking antihypertensives, statins, and platelet inhibitors. The team was unable to assess patients’ estimated glomerular filtration rate, which was a study limitation.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

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Fangel MV, Nielsen PB, Kristensen JK, et al. 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 [published online March 20, 2020]. Am J Med. doi: 10.1016/j.amjmed.2019.10.042