Urinary Albumin-to-Creatinine Ratio Aids CV Risk Assessment in T2D

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Patients with T2D and elevated urinary albumin-to-creatinine ratio may be at higher risk for adverse CV events and all-cause mortality.
Patients with T2D and elevated urinary albumin-to-creatinine ratio may be at higher risk for adverse CV events and all-cause mortality.

Elevated urinary albumin-to-creatinine ratio (UACR) is independently associated with an increased risk for all-cause mortality and several adverse cardiovascular events in patients with type 2 diabetes, according to study findings published in JAMA Cardiology.

Investigators analyzed data from the Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus-Thrombolysis in Myocardial Infarction 53 study (SAVOR-TIMI; NCT01107886), which assessed safety outcomes of saxagliptin vs placebo in patients with type 2 diabetes with cardiovascular disease (CVD) or risk factors for heart disease.

In this analysis, researchers sought to determine whether UACR provides incremental prognostic utility beyond established risk factors and cardiovascular (CV) biomarkers in 15,760 patients in the SAVOR-TIMI 53 study.

UACR levels were <10 mg/g in 5805 patients (36.8%), 10 to 0 mg/g in 3891 patients (24.7%), 30 to 300 mg/g in 4426 patients (28.1%), and >300 mg/g in 1638 patients (10.4%). A stepwise increase was observed with each higher UACR category in relation to CV death (1.4%, 2.6%, 4.1%, and 6.9%), hospitalization for heart failure (1.5%, 2.5%, 4.0%, and 8.3%), and the incidence of the primary composite end point of CV death, ischemic stroke, or myocardial infarction (3.9%, 6.9%, 9.2%, and 14.3%, respectively; adjusted P <.001 for trend).

In addition, there was a stepwise increase in CV risk in patients with a UACR >0 mg/g within each category of chronic kidney disease. There were also associations between UACR and CV outcomes in saxagliptin- and placebo-treated patients (P >.05 [all outcomes]; P =.033 [ischemic stroke]).

At baseline, researchers measured UACR once, which may have increased the likelihood of intrapatient sampling variability. Investigators did not account for medication, glycemic, or blood pressure changes after baseline, further limiting the study's ability to determine whether any differences in these variables may have had an impact on the association between UACR and CV outcomes.

The researchers concluded that the prognostic “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.”

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

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