[Microalbuminuria and clinical proteinuria as the main predictive factors of cardiovascular morbidity and mortality in patients with type 2 diabetes].
BACKGROUND
[corrected] The principal objective was that of evaluating the independent contribution of microalbuminuria and clinical proteinuria to the cardiovascular morbidity and mortality in patients with type 2 diabetes.


METHODS
A prospective cohort study with selection of patients with type 2 diabetes evaluated in hospital outpatient consultations. Through the Cox proportional risks model the predictive importance of the presence of microalbuminuria and clinical proteinuria on the appearance of fatal and non-fatal cardiovascular complications (angina, fatal and non-fatal myocardial infarction, sudden death, transitory ischemic attack, fatal and non-fatal stroke, or amputation of lower limbs) was analyzed.


RESULTS
The monitoring of 463 patients was done during an average period of 4.64 years (SD: 1.56). There were 330 patients (71.3%) with normoalbuminuria, 106 (22.9%) with microalbuminuria and 27 (5.8%) with proteinuria. The global cardiovascular morbidity and mortality rate was 3.7% annual (2.46% annual for the patients with normoalbuminuria, 5.6% for the patients with microalbuminuria and 14.42% for the patients with proteinuria; p < 0.0001). After multiple adjustment, both microalbuminuria (RR: 1.91; 95% CI: 1.05-3.48; p = 0.032) and proteinuria (RR: 4.15; 95% CI: 1.77-9.75; p = 0.0011) were the main independent predictive factores of appearance of cardiovascular complications. Other predictive variables were age (RR: 1.06; 95% CI: 1.02-1.10; p = 0.0014), HDL cholesterol (RR = 0.96; 95% CI: 0.93-0.98; p = 0.001), LDL cholesterol (RR: 1.01; 95% CI: 1.002-1.02; p = 0.016) and initial presence of ischemic cardiopathy (RR: 1.97; 95% CI: 1.03-3.76; p = 0.041).


CONCLUSIONS
The increase in the rate of excretion of urinary albumin is the main independent predictive factor of cardiovascular morbidity and mortality in patiens with type 2 diabetes.
Gimeno Orna
J A
JA
Secciones de Medicina Interna. Hospital Comarcal de Alcañiz. Teruel. Spain.
Boned Juliani
B
B
Lou Arnal
L M
LM
Castro Alonso
F J
FJ
D000368:Aged; D000419:Albuminuria / Q000209:etiology*; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications*; D003925:Diabetic Angiopathies / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D011507:Proteinuria / Q000209:etiology*