Lower Albuminuria Levels Mean Lower CVD Risk in Diabetes Patients

A higher urinary albumin to creatinine ratio (UACR) is associated with an increased risk for adverse cardiovascular events among patients with type 2 diabetes, according to the findings of a recent study. However, UACR provided minimal prognostic value compared with other cardiac biomarkers for assessing cardiovascular disease (CVD) risk.

The researchers conducted the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus-Thrombolysis in Myocardial Infarction (SAVOR-TIMI) 53 study, which included 15,760 patients with type 2 diabetes and CVD or multiple CVD risk factors at baseline who were randomly assigned to either saxagliptin or placebo and followed for a median 2.1 years.
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Using baseline UACRs, the researchers categorized participants into thresholds and evaluated the prognostic benefits of UACR compared with established plasma cardiovascular biomarkers. The primary composite endpoint included cardiovascular death, myocardial infarction, or ischemic stroke.

A total of 5805 (36.8%) patients had UACRs below 10 mg/g, 3891 (24.7%) patients had UACRs of 10 to 30 mg/g, 4426 (28.2%) patients had UACRs of 30 to 300 mg/g, and 1638 (10.4%) patients had UACRs above 300 mg/g.

In analysis that excluded cardiac biomarkers, the researchers observed a stepwise increase in the incidence of the composite primary endpoint within each increase in UACR, as well as the incidence of cardiovascular death alone and hospitalization for heart failure. While UACR was associated with cardiovascular outcomes after the researchers included cardiac biomarkers, the improvement in discrimination and reclassification was attenuated.

“In patients with type 2 diabetes, UACR was independently associated with increased risk for a spectrum of adverse cardiovascular outcomes,” the researchers concluded. “However, the incremental cardiovascular prognostic value of UACR was minimal when evaluated together with contemporary cardiac biomarkers.”

“Thus the utility of using UACR as a tool for cardiovascular risk assessment in patients with [type 2 diabetes] is dependent on whether established cardiac biomarkers are also being assessed simultaneously.”

—Melissa Weiss

Reference:

Scirica BM, Mosenzon O, Bhatt DL, et al. Cardiovascular outcomes according to urinary albumin and kidney disease in patients with type 2 diabetes at high cardiovascular risk: observations from the SAVOR-TIMI 53 trial [published online December 6, 2017]. JAMA Cardiol. doi:10.1001/jamacardio.2017.4228.