title: Usefulness of albuminuria as predictor for coronary artery stenosis, regardless of estimated glomerular filtration rate, in patients with type 2 diabetes mellitus.
abstract: The aim of the present study was to evaluate the independent predictors of coronary artery stenosis in patients with type 2 diabetes mellitus (DM) and subclinical atherosclerosis. A total of 232 patients with type 2 DM and subclinical atherosclerosis underwent multislice computed tomography coronary angiography. Subclinical atherosclerosis was determined by the carotid intima-media thickness (IMT) or carotid plaque. Multislice computed tomography coronary angiography revealed significant coronary stenosis (>50% in diameter) in 71 subjects (31%). The subjects who had significant coronary stenosis were much older and had had a longer duration of DM. In particular, the log-transformed albumin/creatinine ratio (ACR) was greater in the subjects with significant coronary stenosis compared to the subjects without significant coronary stenosis. The age- and gender-adjusted odds ratio for significant coronary stenosis increased in proportion to albuminuria with a given estimated glomerular filtration rate. The ACR as a continuous variable (odds ratio 4.167, 95% confidence interval 1.497 to 11.599) or categorical variable (ACR >30 μg/mg, odds ratio 4.619, 95% confidence interval 1.562 to 13.659) was associated with an increased risk of significant coronary stenosis, independent of conventional cardiovascular risk factors. In receiver operating characteristic analysis, the ACR had an additive effect with carotid IMT for predicting significant coronary stenosis (area under the curve 0.625 with carotid IMT; area under the curve 0.710 with carotid IMT plus ACR, p = 0.0144). In conclusion, the presence of albuminuria is an independent predictor for significant coronary stenosis in patients with type 2 DM and subclinical atherosclerosis.
authors.affiliation: Division of Endocrinology and Metabolism, Department of Internal Medicine, Catholic University of Korea, Bucheon St. Mary's Hospital, Bucheon, Korea.
authors.forename: Jang-Won
authors.initials: JW
authors.lastname: Son
authors.forename: Eun-Hee
authors.initials: EH
authors.lastname: Jang
authors.forename: Mee-Kyoung
authors.initials: MK
authors.lastname: Kim
authors.forename: Hyo-Lim
authors.initials: HL
authors.lastname: Kim
authors.forename: Ki-Hyun
authors.initials: KH
authors.lastname: Baek
authors.forename: Ki-Ho
authors.initials: KH
authors.lastname: Song
authors.forename: Soon Jib
authors.initials: SJ
authors.lastname: Yoo
authors.forename: Kun-Ho
authors.initials: KH
authors.lastname: Yoon
authors.forename: Bong-Yun
authors.initials: BY
authors.lastname: Cha
authors.forename: Kwang-Woo
authors.initials: KW
authors.lastname: Lee
authors.forename: Ho-Young
authors.initials: HY
authors.lastname: Son
authors.forename: Hyuk-Sang
authors.initials: HS
authors.lastname: Kwon
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000209:etiology* / Q000503:physiopathology / Q000652:urine; D017023:Coronary Angiography; D023921:Coronary Stenosis / Q000150:complications* / Q000000981:diagnostic imaging; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000503:physiopathology / Q000652:urine; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012372:ROC Curve; D012189:Retrospective Studies; D012307:Risk Factors; D014057:Tomography, X-Ray Computed