The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus
The risk of cardiovascular disease mortality associated with microalbuminuria and gross proteinuria in persons with older-onset diabetes mellitus
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DOI：
10.1001/archinte.160.8.1093
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发表时间：
2000-04-24
影响因子：
--
通讯作者：
Klein, BEK
中科院分区：
文献类型：
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作者：
Valmadrid, CT;Klein, R;Klein, BEK
背景：尽管大量研究表明蛋白尿与2型糖尿病全因死亡风险增加之间的关系，但微量蛋白尿和/或总蛋白尿是否是心血管死亡的独立危险因素仍不确定。此外，在美国人群中，蛋白尿与2型糖尿病患者心血管死亡率的关系尚未得到很好的描述。目的：评估老年糖尿病患者微量白蛋白尿和总蛋白尿与心血管疾病死亡率相关的相对危险度（rr）。方法：我们对840名老年糖尿病患者进行了一项前瞻性队列研究，这些患者在1984-1986年的糖尿病人群研究中提供了尿液样本。微量白蛋白尿的存在通过凝集抑制试验和总蛋白尿通过试剂条测定。主要结果是从死亡证明确定的心血管疾病死亡时间。结果：840例老年糖尿病患者中，正常蛋白尿占54.8%，微量蛋白尿占24.8%，总蛋白尿占20.5%。在12年的随访期间（6127人年），我们确定了364例心血管疾病死亡。与正常蛋白尿患者相比，微量蛋白尿和总蛋白尿患者心血管死亡的风险明显更高。在年龄、性别、血糖控制、胰岛素使用、酒精摄入、体力活动、心血管病史、抗高血压药物使用和视网膜病变严重程度等因素的对照下，微量白蛋白尿患者的RR为1.84(95%可信区间[CI]， 1.42-2.40)，总蛋白尿患者的RR为2.61（95%可信区间[CI]， 1.99-3.43）。进一步调整其他因素并没有改变我们发现的关系。当终点为冠心病、中风或所有原因导致的死亡率时，微量蛋白尿（校正后的RRs分别为[95% ci]、1.96[1.42-2.72]、2.20[1.29-3.75]和1.68[1.35-2.09]）和总蛋白尿（校正后的RRs分别为[95% ci]、2.73[1.95-3.81]、2.33[1.28-4.24]和2.47[1.97-3.10]）的风险均显著增加。结论：我们基于人群的研究结果强烈表明，微量白蛋白尿和总蛋白尿与所有原因以及心脑血管和冠心病的死亡率显著相关。这些关联与已知的心血管危险因素和糖尿病相关变量无关。
Background: Despite the numerous studies on the relation of albuminuria with increased risk of all-cause mortality in type 2 diabetes mellitus, it remains uncertain whether microalbuminuria and/or gross proteinuria are independent risk factors for cardiovascular mortality. Moreover, the association of albuminuria with cardiovascular mortality in people with type 2 diabetes mellitus has not been well described in US populations.Objective: To estimate the relative risks (RRs) for the associations of microalbuminuria and gross proteinuria with cardiovascular disease mortality among persons with older-onset diabetes mellitus.Methods: We conducted a prospective cohort study of 840 people with older-onset diabetes mellitus who provided urine samples in the 1984-1986 examination of a population-based study of diabetic persons. The presence of microalbuminuria was determined by an agglutination inhibition assay and gross proteinuria by a reagent strip. The main outcome was time to mortality from cardiovascular disease, as determined from death certificates.Results: Of the 840 older-onset diabetic persons, 54.8% had normoalbuminuria, while 24.8% had microalbuminuria and 20.5% had gross proteinuria. During the 12-year follow-up (6127 person-years), we identified 364 deaths from cardiovascular disease. Compared with persons with normoalbuminuria, those with microalbuminuria and gross proteinuria had significantly higher risks of cardiovascular mortality. The RR as controlled for age, sex, glycemic control, insulin use, alcohol intake, physical activity, cardiovascular disease history, antihypertensive use, and retinopathy severity, was 1.84 (95% confidence interval [CI], 1.42-2.40) for those with microalbuminuria and 2.61 (95% CI, 1.99-3.43) for those with gross proteinuria. Further adjustment for other factors did not change the relations we found. When the end point used was mortality from coronary heart disease, stroke, or all causes, the increased risks were significant for both microalbuminuria (adjusted RRs [95% CIs], 1.96 [1.42-2.72], 2.20 [1.29-3.75], and 1.68 [1.35-2.09], respectively) and gross proteinuria (adjusted RRs [95% CIs], 2.73 [1.95-3.81], 2.33 [1.28-4.24], and 2.47 [1.97-3.10], respectively).Conclusions: Results from our population-based study strongly suggest that both microalbuminuria and gross proteinuria were significantly associated with subsequent mortality from all causes and from cardiovascular, cerebrovascular, and coronary heart diseases. These associations were independent of known cardiovascular risk factors and diabetes-related variables.