title: Urinary albumin levels in the normal range determine arterial wall thickness in adults with Type 2 diabetes: a FIELD substudy.
abstract: OBJECTIVE
  Cardiovascular disease (CVD) rates are substantially higher among patients with Type 2 diabetes than in the general population. The objective of this study was to identify the determinants of carotid intima media thickness (IMT) in patients with Type 2 diabetes.
  
  
  METHODS
  We measured the thickness of the intima media layer of the carotid artery, a strong predictor of the risk of future vascular events, in 397 Type 2 diabetic patients drawn from the Fenofibrate Intervention and Event Lowering in Diabetes study, prior to treatment allocation.
  
  
  RESULTS
  The mean IMT was 0.78 mm [interquartile range (IQR) 0.23 mm], and the maximum IMT was 1.17 mm (IQR 0.36 mm). By multivariate analysis, age, sex, duration of diabetes, triglycerides, and total cholesterol were independently correlated with IMT, as was urine albumin-creatinine ratio (ACR) (P < 0.001). The effect of ACR on IMT was further examined by tertile. Clinically significant differences in IMT were associated with ACR > 0.65 mg/mmol, approximately one-fifth the standard clinical threshold for microalbuminuria (P < 0.01). Long-term diabetes, independent of other parameters, was associated with a 50% increase in age-related thickening.
  
  
  CONCLUSIONS
  IMT in people with Type 2 diabetes is independently and continuously related to urine albumin levels and to the duration of diabetes. These results support previous data linking urine albumin measurements within the normal range with increased ischaemic cardiac mortality in the setting of Type 2 diabetes, and strongly suggest that urine albumin levels within this range should trigger a formal evaluation for CVD.
authors.affiliation: NHMRC Clinical Trials Centre, University of Sydney, Sydney NSW 2006, Australia. tony@ctc.usyd.edu.au
authors.forename: A C
authors.initials: AC
authors.lastname: Keech
authors.forename: S M
authors.initials: SM
authors.lastname: Grieve
authors.forename: A
authors.initials: A
authors.lastname: Patel
authors.forename: K
authors.initials: K
authors.lastname: Griffiths
authors.forename: M
authors.initials: M
authors.lastname: Skilton
authors.forename: G F
authors.initials: GF
authors.lastname: Watts
authors.forename: T H
authors.initials: TH
authors.lastname: Marwick
authors.forename: M
authors.initials: M
authors.lastname: Groshens
authors.forename: D S
authors.initials: DS
authors.lastname: Celermajer
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology*; D015415:Biomarkers / Q000652:urine; D002339:Carotid Arteries / Q000000981:diagnostic imaging*; D003404:Creatinine / Q000652:urine; D003924:Diabetes Mellitus, Type 2 / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D003925:Diabetic Angiopathies / Q000150:complications / Q000175:diagnosis* / Q000652:urine; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012016:Reference Values; D012307:Risk Factors; D014463:Ultrasonography
chemical_list: D015415:Biomarkers; D003404:Creatinine