title: A prospective two-center study on the associations between microalbuminuria, coronary atherosclerosis and long-term clinical outcome in asymptomatic patients with type 2 diabetes mellitus: evaluation by coronary CT angiography.
abstract: This study assessed the associations between microalbuminuria in asymptomatic patients with type 2 diabetes and the presence, extent, and severity of coronary atherosclerosis, as measured by coronary computed tomography angiography (CCTA), and the long-term clinical outcomes. In total, the study enrolled 284 consecutive eligible asymptomatic patients with type 2 diabetes and without known coronary artery disease (CAD), who then underwent CCTA and 24 h urine albumin measurements. Microalbuminuria was defined as 30-300 mg/day urinary albumin excretion. Obstructive CAD, as measured by CCTA, was defined as maximum intra-luminal stenosis ≥50 %. Patients with and without microalbuminuria were compared in terms of obstructive CAD prevalence, and the extent and severity of coronary atherosclerosis. They were evaluated using the following data: coronary artery calcium score (CACS), atheroma burden obstructive score (ABOS), segment involvement score (SIS) and segment stenosis score (SSS). All-cause mortality within a follow-up period of 5 years was also compared. Compared to patients without microalbuminuria, patients with microalbuminuria were more likely to have obstructive CAD (p = 0.004). Microalbuminuria was associated with higher ABOS (p = 0.010), SIS (p = 0.029), and SSS (p = 0.011), except for CACS (p = 0.058). Multivariable analyses adjusted for conventional cardiovascular risk factors revealed that microalbuminuria was an independent predictor of obstructive CAD [odds ratio 2.255, confidence intervals (CI) 1.121-4.538, p = 0.023] and all-cause mortality (hazard ratio 3.469, CI 1.319-9.121, p = 0.012). In asymptomatic patients with type 2 diabetes, microalbuminuria was associated with increased risk of CAD and poorer clinical outcomes.
authors.affiliation: Cardiovascular Center and Cardiology Division, Seoul St. Mary's Hospital, The Catholic University of Korea, Banpodong 505, Seochogu, Seoul, 137-701, Republic of Korea.
authors.forename: Jin-Jin
authors.initials: JJ
authors.lastname: Kim
authors.forename: Byung-Hee
authors.initials: BH
authors.lastname: Hwang
authors.forename: Ik Jun
authors.initials: IJ
authors.lastname: Choi
authors.forename: Eun-Ho
authors.initials: EH
authors.lastname: Choo
authors.forename: Sungmin
authors.initials: S
authors.lastname: Lim
authors.forename: Yoon-Seok
authors.initials: YS
authors.lastname: Koh
authors.forename: Jong Min
authors.initials: JM
authors.lastname: Lee
authors.forename: Pum-Joon
authors.initials: PJ
authors.lastname: Kim
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
authors.forename: Seung-Hwan
authors.initials: SH
authors.lastname: Lee
authors.forename: Jae-Hyung
authors.initials: JH
authors.lastname: Cho
authors.forename: Jung Im
authors.initials: JI
authors.lastname: Jung
authors.forename: Kiyuk
authors.initials: K
authors.lastname: Chang
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000209:etiology*; D058070:Asymptomatic Diseases; D016009:Chi-Square Distribution; D017023:Coronary Angiography / Q000379:methods*; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D023921:Coronary Stenosis / Q000000981:diagnostic imaging / Q000209:etiology* / Q000401:mortality; D003331:Coronary Vessels / Q000000981:diagnostic imaging*; D003924:Diabetes Mellitus, Type 2 / Q000150:complications* / Q000175:diagnosis / Q000401:mortality; D003928:Diabetic Nephropathies / Q000175:diagnosis / Q000209:etiology* / Q000401:mortality; D018450:Disease Progression; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D061330:Multidetector Computed Tomography; D015999:Multivariate Analysis; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D011446:Prospective Studies; D012042:Registries; D056910:Republic of Korea; D012307:Risk Factors; D012720:Severity of Illness Index; D013997:Time Factors