High-normal albumin-to-creatinine ratio associated with CV events in type 2 diabetes

Patients with an elevated urinary albumin-to-creatinine ratio, even below 30 mg/g, were at increased risk for major adverse cardiovascular (CV) events, a post hoc analysis of the ACCORD trial found.

Patients with type 2 diabetes and an elevated urinary albumin-to-creatinine ratio (UACR) may be at higher risk for adverse cardiovascular events, according to a recent study.

A UACR below 30 mg/g is recommended by the American Diabetes Association for patients with type 2 diabetes, while recent research has indicated that risk for adverse outcomes is increased in those with high-normal values. Researchers performed a post hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and its follow-up study, ACCORDIAN, to evaluate the relationship between UACR and major cardiovascular events (MACE) as well as total mortality in patients with type 2 diabetes. The study results were published Oct. 31 by the Journal of Clinical Endocrinology & Metabolism.

A total of 10,171 patients with UACR data at baseline were included in the analysis. Approximately 61% were male, the mean age was approximately 63 years, and approximately 63% were White. The researchers calculated the natural logarithm (ln) of each UACR measurement. Patients were divided into tertiles according to ln (100 × UACR), with low (4.27 to 6.73 mg/g), middle (6.73 to 7.88 mg/g), and high (7.88 to 14.07 mg/g) ranges and corresponding UACRs of 0.72 to 8.33, 8.33 to 26.52, and 26.52 to 12,908.16, respectively. Over a median of 8.83 years of follow-up, 1,808 patients (17.78%) had MACEs and 1,934 (19.01%) died.

In a multivariate analysis, there was a significant association between the UACR and risk for MACEs and total mortality after adjustment for traditional cardiovascular risk factors. The conventional risk model was better able to predict MACE and total mortality when UACR was also included. Patients with type 2 diabetes and an ln (100 × UACR) in the middle range had a 35% higher risk for MACE and a 42% higher risk for total mortality than those in the low ln range. Those with a high-normal UACR had higher risk for MACE and total mortality.

Both ACCORD and ACCORDIAN evaluated high-risk patients, so the potential effectiveness of the UACR in other populations is not known, the authors noted. They also acknowledged that some confounders may have been missed and that changes in the UACR were not monitored continuously during follow-up. “In conclusion, in our post-hoc analysis of the ACCORD and ACCORDION trials, we discovered that the UACR in patients with T2DM [type 2 diabetes mellitus] could predict the risk of developing MACEs and total mortality even when it was within the normal range,” the authors wrote. “This study offers valuable insights into the assessment of MACEs and total mortality risk in patients with T2DM.”