Department of Diagnostic Imaging, Rhode Island Hospital, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.
Department of Diagnostic Imaging, The Warren Alpert Medical School of Brown University, Providence, Rhode Island, United States.
Catheter Cardiovasc Interv. 2019 Mar 1;93(4):E217-E224. doi: 10.1002/ccd.27890. Epub 2018 Nov 23.
The aim of this study was to examine the relationship of albuminuria to cardiovascular disease outcomes in diabetic patients undergoing treatment for stable coronary artery disease.
We analyzed data from 2176 participants of the Bypass Angioplasty Revascularization Investigation in type-2 diabetes (BARI-2D) trial, a randomized clinical trial comparing Percutaneous coronary intervention/Coronary artery bypass grafting (PCI/CABG) to medical therapy for people with diabetes. The population was stratified by baseline spot urine albumin-creatinine ratio (uACR) into normal (uACR <10 mg/g), mildly (uACR ≥10 mg/g < 30 mg/g), moderately (uACR ≥30 mg/g < 300 mg/g) and severely increased (uACR ≥300 mg/g) groups, and outcomes compared between groups. Death, myocardial infarction (MI) and/or stroke were experienced by 489 patients at a mean follow-up of 4.3 ± 1.5 years. Compared with normal uACR, mildly increased uACR was associated with a 1.4 times (P = 0.042) increase in all-cause mortality. Additionally, nonwhites with type-II diabetes and stable coronary artery disease who had mildly increased albuminuria had a Hazard ratio (HR) of 3.3 times (P = 0.028) for cardiovascular death, 3.1 times for (P = 0.002) all-cause mortality, and two times for (P = 0.015) MI during follow-up.
Mildly increased albuminuria is a significant predictor of all-cause mortality in those with type-II diabetes mellitus and stable coronary artery disease, as well as for cardiovascular events those who are nonwhites.
本研究旨在探讨糖尿病患者在稳定型冠状动脉疾病治疗中蛋白尿与心血管疾病结局的关系。
我们分析了 2176 名 2 型糖尿病旁路血管成形术研究（BARI-2D）试验参与者的数据，这是一项比较经皮冠状动脉介入治疗/冠状动脉旁路移植术（PCI/CABG）与药物治疗对糖尿病患者疗效的随机临床试验。根据基线点尿白蛋白肌酐比（uACR），人群分为正常（uACR<10mg/g）、轻度（uACR≥10mg/g<30mg/g）、中度（uACR≥30mg/g<300mg/g）和重度升高（uACR≥300mg/g）组，并比较组间结局。平均随访 4.3±1.5 年后，489 例患者发生死亡、心肌梗死（MI）和/或卒中。与正常 uACR 相比，轻度 uACR 升高与全因死亡率增加 1.4 倍相关（P=0.042）。此外，患有 2 型糖尿病和稳定型冠状动脉疾病的非白人患者，轻度白蛋白尿患者的心血管死亡风险比（HR）为 3.3 倍（P=0.028），全因死亡率为 3.1 倍（P=0.002），随访期间 MI 为 2 倍（P=0.015）。
轻度升高的白蛋白尿是 2 型糖尿病和稳定型冠状动脉疾病患者全因死亡率的重要预测指标，也是非白人患者心血管事件的重要预测指标。
