title: Increased serum glycated albumin level is associated with the presence and severity of coronary artery disease in type 2 diabetic patients.
abstract: BACKGROUND
  Glycated albumin is the predominant circulating Amadori-type glycated protein in vivo and plays a major role in the development of diabetic vascular complications. The aim of this study was to assess the relationship between increased serum glycated albumin level and the presence and severity of coronary artery disease (CAD) in patients with type 2 diabetes mellitus (T2DM).
  
  
  RESULTS
  In a total of 320 consecutive patients with T2DM, coronary angiography revealed normal coronary arteries in 83 patients (control group) and significant coronary stenosis (> or = 70% luminal diameter narrowing) in 237, of whom 51 patients had 1-vessel disease (Group I), 80 had 2-vessel disease (Group II), and 106 had 3-vessel disease (Group III). Serum glycated albumin, hemoglobin A(1c) (HbA(1c)) and tumor necrosis factor (TNF)-alpha levels, lipid profile, and renal function were measured. Logistic regression analysis was performed to determine the relative risk of serum glycated albumin level for the presence and severity of CAD. Multivariate stepwise linear regression analysis was done to identify independent determinants of the glycated albumin level. Serum glycated albumin (21.2+/-5.3% vs 19.4+/-4.3%, p=0.005) and TNF-alpha levels (123 +/-115 pg/ml vs 65+/-59 pg/ml, p<0.001) were significantly higher in patients with CAD than in controls, but serum HbAlc level did not significantly differ between them (7.6+/-1.3% vs 7.4+/-1.2%, p=0.19). There was a significant difference in serum glycated albumin level between Groups I and III (19.5+/-3.3% vs 21.8+/-5.7%, p<0.001). The serum glycated albumin level correlated with the number of diseased arteries (Spearman r=0.205, p<0.001), and was closely related to serum levels on admission of glucose (r=0.495, p<0.001), TNF-alpha (r=0.123, p=0.028), blood urea nitrogen (r=0.167, p=0.004), triglycerides (r=0.129, p=0.021), and HbA(1c) (r=0.795, p<0.001). Multivariate analysis indicated that serum levels of glucose (p<0.0001), TNF-alpha (p=0.001), blood urea nitrogen (p=0.004) and triglycerides (p=0.035) were independent determinants for glycated albumin. Logistic regression analysis revealed that glycated albumin > or = 19% (odds ratio (OR) 2.9, p<0.001) was an independent predictor for CAD and glycated albumin > or = 21% (OR 2.3, p=0.032) for 3-vessel disease prediction. The area under the receiver-operating characteristic curve for glycated albumin (0.620, 95% confidence interval (CI) 0.548 to 0.691, p=0.001) was superior to that for HbA(1c) (0.543, 95% CI 0.473 to 0.613, p=0.243).
  
  
  CONCLUSIONS
  An increased serum level of glycated albumin is associated with the presence and severity of CAD, and may be useful in screening patients with T2DM.
authors.affiliation: Department of Cardiology, Rui Jin Hospital, Institute of Cardiovascular Diseases, Jiaotong University School of Medicine, Shanghai, People's Republic of China.
authors.forename: Li Jin
authors.initials: LJ
authors.lastname: Pu
authors.forename: Lin
authors.initials: L
authors.lastname: Lu
authors.forename: Wei Feng
authors.initials: WF
authors.lastname: Shen
authors.forename: Qi
authors.initials: Q
authors.lastname: Zhang
authors.forename: Rui Yan
authors.initials: RY
authors.lastname: Zhang
authors.forename: Jian Sheng
authors.initials: JS
authors.lastname: Zhang
authors.forename: Jian
authors.initials: J
authors.lastname: Hu
authors.forename: Zheng Kun
authors.initials: ZK
authors.lastname: Yang
authors.forename: Feng Hua
authors.initials: FH
authors.lastname: Ding
authors.forename: Qiu Jin
authors.initials: QJ
authors.lastname: Chen
authors.forename: Jie
authors.initials: J
authors.lastname: Shen
authors.forename: Dan Hong
authors.initials: DH
authors.lastname: Fang
authors.forename: Sheng
authors.initials: S
authors.lastname: Lou
mesh_terms: D000368:Aged; D001786:Blood Glucose / Q000378:metabolism; D003324:Coronary Artery Disease / Q000097:blood* / Q000209:etiology* / Q000473:pathology; D003924:Diabetes Mellitus, Type 2 / Q000097:blood / Q000150:complications*; D005260:Female; D006442:Glycated Hemoglobin / Q000378:metabolism; D017127:Glycation End Products, Advanced; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011379:Prognosis; D012189:Retrospective Studies; D012709:Serum Albumin / Q000378:metabolism*; D012720:Severity of Illness Index; D014409:Tumor Necrosis Factor-alpha / Q000097:blood; D000093423:Glycated Serum Albumin
chemical_list: D001786:Blood Glucose; D006442:Glycated Hemoglobin; D017127:Glycation End Products, Advanced; D012709:Serum Albumin; D014409:Tumor Necrosis Factor-alpha; D000093423:Glycated Serum Albumin