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

Abstract

Fei Gao,1,* Yang Zhou,2,3,* Xiaoming Yan,4,* Haozhang Huang,2,3,5 Guoxiao Liang,2,3 Yongyi Xie,6 Qijiong Zhu,7 Ziming Chen,8 Bo Wang,2,3 Huanqiang Li,2,3 Ziling Mai,2,3,9 Ming Ying,2,3 Jin Liu,2,3 Shiqun Chen,2,3 Jiyan Chen2,3,10 1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, People’s Republic of China; 2Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China; 3Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China; 4Department of Information Technology, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China; 5The Second School of Clinical Medicine, Southern Medical University, Guangzhou, People’s Republic of China; 6School of Pharmacy, Guangdong Medical University, Dongguan, People’s Republic of China; 7School of Public Health, Guangdong Medical University, Dongguan, People’s Republic of China; 8School of Foreign Studies, Southern Medical University, Guangzhou, People’s Republic of China; 9School of Biology and Biological Engineering, South China University of Technology, Guangzhou, People’s Republic of China; 10Guangdong Provincial People’s Hospital, School of Medicine, South China University of Technology, Guangzhou, People’s Republic of China*These authors contributed equally to this workCorrespondence: Shiqun Chen, Department of Cardiology, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China, Email [email protected] Jiyan Chen, Department of Guangdong Provincial Key Laboratory of Coronary Heart Disease Prevention, Guangdong Cardiovascular Institute, Guangdong Provincial People’s Hospital, Guangdong Academy of Medical Sciences, Guangzhou, People’s Republic of China, Tel [phone]-10528, Fax [phone], Email [email protected]: 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

Keywords

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