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Cohort study of predictive value of urinary albumin excretion for atherosclerotic vascular disease in patients with insulin dependent diabetes

BMJ 1996; 312 doi: https://doi.org/10.1136/bmj.312.7035.871 (Published 06 April 1996) Cite this as: BMJ 1996;312:871
  1. Torsten Deckert, consultanta,
  2. Hiroki Yokoyama, research fellowa,
  3. Elisabeth Mathiesen, research fellowa,
  4. Birgitte Ronn, research fellowa,
  5. Tonny Jensen, research fellowa,
  6. Bo Feldt-Rasmussen, research fellowa,
  7. Knut Borch-Johnsen, research fellowa,
  8. Jan Skov Jensen, research fellowa
  1. a Steno Diabetes Center, Niels Steensensvej 2, DK-2820 Gentofte, Denmark
  1. Correspondence to: Dr Skov Jensen.
  • Accepted 16 January 1996

Abstract

Objective: To examine whether slightly elevated urinary albumin excretion precedes development of atherosclerotic vascular disease in patients with insulin dependent diabetes independently of conventional atherogenic risk factors and of diabetic nephropathy.

Design: Cohort study with 11 year follow up.

Setting: Diabetes centre in Denmark.

Subjects: 259 patients aged 19-51 with insulin dependent diabetes of 6-34 years' duration and without atherosclerotic vascular disease or diabetic nephropathy at baseline.

Main outcome measures: Baseline variables: urinary albumin excretion, blood pressure, smoking habits, and serum concentrations of total cholesterol, high density lipoprotein cholesterol, sialic acid, and von Willebrand factor. End point: atherosclerotic vascular disease assessed by death certificates, mailed questionnaires, and hospital records.

Results: Thirty patients developed atherosclerotic vascular disease during follow up of 2457 person years. Elevated urinary albumin excretion was significantly predictive of atherosclerotic vascular disease (hazard ratio 1.06 (95% confidence interval 1.02 to 1.18) per 5 mg increase in 24 hour urinary albumin excretion, P=0.002). Predictive effect was independent of age; sex; blood pressure; smoking; serum concentrations of total cholesterol, high density lipoprotein cholesterol, sialic acid, and von Willebrand factor; level of haemoglobin A1c; insulin dose; duration of diabetes; and diabetic nephropathy (hazard ratio 1.04 (1.01 to 1.08) per 5 mg increase in 24 hour urinary albumin excretion, P=0.03).

Conclusion: Slightly elevated urinary albumin excretion independently predicted atherosclerotic vascular disease in patients with insulin dependent diabetes.

Key messages

  • Key messages

  • Preliminary studies suggested that this mortality might particularly occur among patients with elevated urinary albumin excretion

  • We studied predictive effect of slightly elevated urinary albumin excretion in development of atherosclerotic vascular disease in 259 patients with insulin dependent diabetes

  • Patients with urinary albumin excretion of 30-300 mg/24 h had 2.5 times higher risk of atherosclerotic vascular disease than those with lower excretion rates

  • The predictive effect was independent of conventional atherogenic risk factors and of development of diabetic nephropathy, and duration and control of diabetes

Footnotes

  • Funding The study was funded by the European Commission Biomed I (BMH1-CT92-1766). JSJ was a research fellow of the Danish Heart Foundation.

  • Conflict of interest None.

  • Accepted 16 January 1996
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