Eight to nine year mortality in known non-insulin dependent diabetics and controls

Abstract

Microalbuminuria is known to predict mortality in elderly, non-insulin dependent diabetic individuals. To test whether this is also so when studied prospectively and over a longer period, we followed 228 persons with known diabetes mellitus and an age and sex matched, non-diabetic cohort for eight to nine years. Both cohorts were found during a population screening in 1981-1982 of 5292 citizens aged 60 to 74 years. At ascertainment extensive clinical and biochemical examinations including determination of urinary albumin were carried out. At May 15, 1990 111 diabetic and 46 non-diabetics had died (P less than 0.0001). In the diabetic cohort the median value of urinary albumin excretion (UAE) was 17.40 micrograms/min. In the group with values at or above 17.40 micrograms/min 62 died, compared with 40 deaths in the group with values below (P = 0.003). In the non-diabetic cohort the median UAE value was 7.52 micrograms/min. In the upper group 26 died, in the lower 15 (P = 0.05). Cox regression analyses showed coefficients of regression for ln(UAE) of 0.333 (P less than 0.001) for the diabetic group and 0.236 (P = 0.048) for the non-diabetic group. In the Cox model for the diabetics, ischemic heart disease was also of independent significance to mortality. The final model for the non-diabetics included hypertension and sex as significant variables. It is concluded that in a prospective study of elderly diabetics urinary albumin excretion rate is the best prognostic factor for long-term mortality.(ABSTRACT TRUNCATED AT 250 WORDS)

Urinary Albumin Excretion

“…On the basis of findings in patients with insulin-dependent or non-insulin-dependent diabetes mellitus, we had previously advanced the hypothesis that microalbuminuria is a marker of a generalized vascular dysfunction (the "Steno Hypothesis" 22 ). In recent years, elevated urinary albumin excretion has been also demonstrated in nondiabetic individuals, 7,[13][14][15][16][17][18][19][20][21][25][26][27][28]42 and it has been found to be associated with elevated blood pressure, dyslipidemia, and high plasma insulin levels. [13][14][15][16][17][18][19][20]27,45 Hypertension and dyslipidemia are both well-established risk factors for the development of cardiovascular disease.…”

“…Key Words: urinary albumin excretion Ⅲ microalbuminuria Ⅲ ischemic heart disease Ⅲ atherosclerosis M icroalbuminuria, ie, slightly elevated urinary albumin excretion, was initially demonstrated in patients with diabetes mellitus, where it was shown to be associated with atherogenic changes in the cardiovascular risk profile, 1,2 and to predict increased mortality and cardiovascular disease. [3][4][5][6][7][8][9][10][11][12] Several studies have demonstrated an association between slightly increased urinary albumin excretion and cardiovascular risk factors, even in the general population. [13][14][15][16][17][18][19] In the Copenhagen City Heart Study, we found that otherwisehealthy individuals with a urinary albumin excretion level Ͼ90th percentile (Ͼ7 g/min) were characterized by higher blood pressures and lower plasma concentrations of apolipoprotein A-1 and HDL cholesterol.…”

Urinary albumin excretion and heart rate variability in obese women

“…1±7 Furthermore, slightly elevated UAE (microalbuminuria) has been reported to be associated with premature mortality in the general population. 8,9 Statistical relationships have been found between UAE and established risk factors for cardiovascular disease (CVD) such as blood pressure, 10±12 dyslipidaemia, 11±13 impaired glucose tolerance, 14 insulin resistance, 15,16 left ventricular hypertrophy 17 and blood coagulation abnormalities as well as disordered endothelial function. 16,18,19 UAE has also been shown to be associated with an increased intima-media thickness of the common carotid artery in hypertensive men with diabetes mellitus.…”

Role of Adiponectin in Development and Progression of Diabetic Complications

“…[62,63] In contrast, in patients with type (2) diabetes, microalbuminuria predicts cardiovascular rather than renal disease. [64][65][66][67][68] It has been suggested that microalbuminuria generally reflects a state of wide-spread endothelial dysfunction and/or vascular damage. [69] Other workers have presented albuminuria as a powerful predictor of progression of nephropathy in patients with type 2 diabetes [70] .…”