Cardiovascular autonomic function is associated with (micro-)albuminuria in elderly Caucasian sujects with impaired glucose tolerance or type 2 diabetes: the Hoorn Study.
OBJECTIVE
To determine whether impaired cardiovascular autonomic function correlates with albuminuria in an age-, sex-, and glucose tolerance-stratified sample of an elderly (50-75 years of age) Caucasian population and to determine whether this association is independent of other determinants of albuminuria.


METHODS
We studied 536 subjects, 256 with normal glucose tolerance, 143 with impaired glucose tolerance (IGT), and 137 with type 2 diabetes. Microalbuminuria was defined as an albumin-to-creatinine ratio of > or =3.0 and < or =30 mg/mmol in an early morning urine sample. We used the deep-breathing test and the lying-to-standing test to obtain 4 measurements of cardiovascular autonomic function: 1) the heart rate (HR) variability during deep breathing, 2) the maximum HR within 15 s after standing up minus the mean HR before standing, 3) the maximum R-R interval between 15 and 30 s after standing up divided by the minimum R-R interval within 15 s after standing up, and 4) the systolic blood pressure in response to standing up. These 4 measurements were summarized in a single cardiovascular autonomic function score (CAFS).


RESULTS
A total of 38 subjects with microalbuminuria and 3 subjects with macroalbuminuria (>30 mg/mmol) were grouped as having albuminuria. In bivariate analyses, albuminuria was associated with age, waist-to-hip ratio, systolic and diastolic blood pressure, calculated glomerular filtration rate, and glucose tolerance status. The mean CAFS was higher in subjects with versus without albuminuria (7.5 vs. 5.9, P<0.001). Multiple logistical regression analyses revealed that the CAFS was independently associated with albuminuria in subjects with IGT or type 2 diabetes with an odds ratio (95% CI) of 1.19 (1.02-1.39) per point increase in the CAFS.


CONCLUSIONS
Impaired cardiovascular autonomic function is independently associated with (and thus a possible contributor to) the presence of albuminuria in subjects with IGT or type 2 diabetes.
Smulders
Y M
YM
Department of Internal Medicine, Academic Medical Center, Amsterdam, The Netherlands. y.m.smulders@amc.uva.nl
Jager
A
A
Gerritsen
J
J
Dekker
J M
JM
Nijpels
G
G
Heine
R J
RJ
Bouter
L M
LM
Stehouwer
C D
CD
D000368:Aged; D000419:Albuminuria; D001341:Autonomic Nervous System / Q000503:physiopathology; D001786:Blood Glucose / Q000378:metabolism; D001794:Blood Pressure; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000503:physiopathology* / Q000652:urine; D005260:Female; D005919:Glomerular Filtration Rate; D005951:Glucose Tolerance Test; D006339:Heart Rate; D006710:Homocysteine / Q000097:blood; D006801:Humans; D008055:Lipids / Q000097:blood; D008875:Middle Aged; D009426:Netherlands; D016017:Odds Ratio; D012307:Risk Factors; D044465:White People
D001786:Blood Glucose; D008055:Lipids; D006710:Homocysteine; D003404:Creatinine