High normal albuminuria is associated with arterial stiffness and carotid atherosclerosis in Korean patients with type 2 diabetes.
OBJECTIVE
Current evidence suggests that high normal albuminuria is significantly associated with increased cardiovascular risk. This study investigated the association between urine albumin-to-creatinine ratio (ACR) within the normal range and subclinical atherosclerosis in Korean patients with type 2 diabetes.


RESULTS
This cross-sectional study involved 521 type 2 diabetic patients with normoalbuminuria. Brachial-ankle pulse wave velocity (baPWV) measurement and ultrasound assessment of carotid atherosclerosis was done. Subclinical atherosclerosis was assessed by the presence of high baPWV (>1682 cm/s), carotid atherosclerosis (intima-media thickness >0.8 mm or the presence of plaques), and carotid stenosis (≥50% of luminal narrowing). Across the tertiles of ACR, there was a trend for an increasing prevalence of high baPWV (16.8%, 20.0%, and 38.2%, P < 0.001), carotid atherosclerosis (46.9%, 55.4%, and 64.7%, P < 0.001), and carotid stenosis (12.7%, 16.0%, and 30.1%, P < 0.001). In multivariate analysis, patients in the highest ACR tertile had an odds ratio of 2.05 (95% confidence interval [CI], 1.13-3.72, P = 0.019) for high baPWV, 1.78 (95% CI, 1.08-2.93, P = 0.024) for carotid atherosclerosis, and 2.72 (95% CI, 1.44-5.11, P = 0.002) for carotid stenosis compared to those in the lowest tertile. The relation of ACR with carotid atherosclerosis and stenosis remained significant even in patients without diabetic retinopathy.


CONCLUSIONS
High normal albuminuria was significantly associated with atherosclerotic vascular changes, independent of retinopathy and other cardiovascular risk factors. High normal albuminuria may be an early marker for subclinical atherosclerosis in type 2 diabetes.
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Republic of Korea; Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
H E
HE
Yoon
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea. Electronic address: 13900@catholic.ac.kr.
E S
ES
Kim
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
E Y
EY
Mo
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Republic of Korea; Division of Nephrology, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
S J
SJ
Shin
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
S D
SD
Moon
Department of Internal Medicine, The Catholic University of Korea, College of Medicine, Republic of Korea; Division of Endocrinology and Metabolism, Department of Internal Medicine, Incheon St. Mary's Hospital, Incheon, Republic of Korea.
J H
JH
Han
D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000652:urine*; D055109:Ankle Brachial Index / Q000706:statistics & numerical data; D015415:Biomarkers / Q000652:urine; D002339:Carotid Arteries / Q000000981:diagnostic imaging* / Q000473:pathology; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000652:urine*; D059168:Carotid Intima-Media Thickness / Q000706:statistics & numerical data; D016893:Carotid Stenosis / Q000652:urine; D003404:Creatinine / Q000652:urine*; D003430:Cross-Sectional Studies; D003924:Diabetes Mellitus, Type 2 / Q000503:physiopathology / Q000652:urine*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D059289:Vascular Stiffness
D015415:Biomarkers; D003404:Creatinine
Albuminuria; Atherosclerosis; Brachial-ankle pulse wave velocity; Carotid intima-media thickness; Carotid plaque; Type 2 diabetes