Association of albuminuria with all-cause and cardiovascular disease mortality in diabetes: the Strong Heart Study

Abstract

Objectives — To estimate the relative risks of albuminuria with all-cause and cardiovascular disease (CVD) mortality in a large cohort of American Indians with diabetes. Methods — A total of 1,953 diabetic participants in the Strong Heart Study were evaluated based on albuminuria categories at baseline examination. The Cox proportional hazards model was used to examine associations. Results — Of the 1,953 participants, 605 (31%) and 410 (21%) had microalbuminuria and macroalbuminuria, respectively, at baseline examination. Microalbuminuria (HR=1.42, 95% CI 1.15—1.77 for all-cause, and HR=1.48, CI 1.01—2.17 for CVD), and macroalbuminuria (HR=3.39, CI 2.71—4.25 for all-cause, and HR=3.74, CI 2.56—5.47 for CVD) were significant predictors for all-cause and CVD mortality after adjustment for other CVD risk factors. Conclusions — Results from the present study suggest that albuminuria is a strong independent predictor of all-cause and CVD Mortality in American Indians with diabetes.

Keywords

albuminuria cardiovascular disease mortality association diabetes American Indians.

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References

Mogensen CE Microalbuminuria predicts clinical proteinuria and early mortality in maturity onset diabetes . N Engl J Med 1984 ;310:356-60.

Jones CA , Francis ME , Eberhardt MS et al. Microalbuminuria in the US Population: third National Health and Nutrition Examination Survey . Am J Kidney Dis 2002;39:445-59.

Klein R. , Klein Bek , Moss S. , DeMets DL Proteinuria in diabetes . Arch Intern Med 1988 ;148:181-6.

Gall MA , Rossing P. , Skott P. et al. Prevalence of micro- and macroalbuminuria, arterial hypertension, retinopathy and large vessel disease in European Type 2 (non-insulin-dependent) diabetic patients . Diabetologia 1991;34:655-61.

Bruno G. , Cavall0-Perin P. , Bargero G. et al. Prevalence and risk factors for micro- and macroalbuminuria in an Italian population-based cohort of NIDDM subjects . Diabetes Care 1996;19:43-7.

Nelson RG , Kunzelman CL , Pettitt DJ , Saad MF , Bennett PH , Knowler WC Albuminuria in type 2 (non-insulin-dependent) diabetes mellitus and impaired glucose tolerance in Pima Indians . Diabetologia 1989;32: 870-6

Knowler WC , Kunzelman CL Population comparison of the frequency of diabetic nephropathy. In: Mogensen CE (Ed.) The kidney and hypertension in diabetes mellitus. Nijhoff, Boston,1988: 25-32.

Haffner SM , Mitchell BD , Pugh JA et al. Proteinuria in Mexican Americans and non-hispanic whites with NIDDM . Diab Care 1989;12:530-6.

Samanta A. , Burden AC , Feehally J. , Walls J. Diabetic renal disease: differences between Asian and white patients . BMJ 1986;293:366-7.

10.

Arun CS , Stoddart J. , Mackin P. , MacLeod J. , New JP , Marshall SM Significance of microalbuminuria in long-duration type 1 diabetes . Diabetes Care 2003;26:2144-9.

11.

Niskannen LK , Penttila I. , Parviainen M. , Uusitupa M. Evolution, risk factors, and prognostic implications of albuminuria in NIDDM . Diabetes Care 1996 ;19:486-93.

12.

Dinneen SF , Gerstein HC The association of microalbuminuria and mortality in non-insulin-dependent diabetes mellitus: a systematic overview of the literature . Arch Intern Med 1997;157:1413-18.

13.

Jager A. , Kostense PJ , Ruhe HG et al. Microalbuminuria and peripheral arterial disease are independent predictors of cardiovascular and all-cause mortality, especially among hypertensive subjects: five-year follow-up of the Hoorn Study . Arterioscler Thromb Vasc Biol 1999;19:617-24.

14.

Romundstad S. , Holmen J. , Hallan H. , Kvenild K. , Ellekjaer H. Microalbuminuria and all-cause mortality in treated hypertensive individuals: does sex matter? The Nord-Trøndelag Health Study (HUNT), Norway . Circulation 2003;108:2783-9.

15.

Hillege HL , Fidler V. , Diercks GFH et al. for the Prevention of Renal and Vascular End Stage Disease (PREVEND) Study Group : Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population . Circulation 2002;106:1777-82.

16.

Yuyun MF , Khaw KT , Luben R. et al. Microalbuminuria independently predicts all-cause and cardiovascular mortality in a British population: The European Prospective Investigation into Cancer in Norfolk (EPIC-Norfolk) population study . IJE 2004;33:189-98.

17.

Nelson RG , Pettitt DJ , Carraher MJ , Baird HR , Knowler WC The effect of proteinuria on mortality in non-insulin-dependent diabetes mellitus . Diabetes 1988;37:1499-504.

18.

Lee ET , Welty TK , Fabsitz R. et al. A study of cardiovascular disease in American Indians: design and methods. The Strong Heart Study . Am J Epidemiol 1990;132:1141-55.

19.

Lee ET , Cowan LD , Welty TK et al. All-cause mortality and cardiovascular disease mortality in three American Indian populations, Aged 45-74 Years, 1984-88: The Strong Heart Study . Am J Epidemiol 1998;147:995-1008.

20.

Lee ET , Welty TK , Cowan LD et al. Incidence of diabetes mellitus in American Indians of three geographic areas: The Strong Heart Study . Diabetes Care 2002;25:49-54.

21.

Robbins DC , Knowler WC , Lee ET et al. Regional differences in albuminuria among American Indians: An epidemic of renal disease . Kidney Int 1996 ;49:557-63.

22.

Howard BV , Lee ET , Cowan LD et al. Rising tide of cardiovascular disease in American Indians. The Strong Heart Study. Circulation 1999;99:2389-95.

23.

Chasson AL , Grady HJ , Stanley MA Determination of creatinine by means of automatic chemical analysis . Tech Bull Regist Med Tech 1957; 30:207-12.

24.

Vasquez B. , Flock EV , Savage PJ et al. Sustained reduction in proteinuria in type 2 (non-insulin dependent) following diet-induced reduction of hyperglycemia . Diabetologia 1984;26:27-33.

25.

The Expert Committee on the Diagnosis and Classification of Diabetes Mellitus. Report of the Expert Committee on the diagnosis and classification of diabetes mellitus . Diabetes Care 1997;20:1183-97.

26.

Young TK The health of Native American Indians: towards a biocultural epidemiology . Oxford University Press , 1994.

27.

Howard BV , Lee ET , Cowan LD et al. Coronary heart disease prevalence and its relation to risk factors in American Indians: the Strong Heart Study . Am J Epidemiol 1995;142:254-68.

28.

Cox DR Regression models and life tables . JR Stat Soc B 1972;34:187-220.

29.

Lee ET , Wang WY Statistical methods for survival data analysis, third edition. John Wiley & Sons, Inc., New Jersey, 2003.

30.

SAS: SAS Release 8.1. Cary, NC, SAS Institute, 2000.

31.

American Diabetes Association: Standards of medical care for patients with diabetes mellitus (Position Statement) . Diabetes Care 1995;18 (suppl 1):8-15.

32.

Bennett PH , Haffner S. , Kasiske BL et al. Screening and management of microalbuminuria in patients with diabetes mellitus: recommendations to the Scientific Advisory Board of the National Kidney Foundation from an ad hoc committee of the Council on Diabetes Mellitus of the National Kidney Foundation . Am J Kidney Dis 1995;25:107-12.

33.

Liu JE , Robbins DC , Palmieri V. et al. Association of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes: the Strong Heart Study . JACC 2003;41:2022-8.

34.

Deckert T. , Feldt-Rasmussen B. , Borch-Johnsen K. , Jensen T. , Kofoed-Enevoldsen A. Albuminuria reflects widespread vascular damage: the Steno hypothesis . Diabetologia 1989;32:219-26.

35.

Mattock MB , Barnes DJ , Viberti GC et al. Microalbuminuria and coronary heart disease in NIDDM: An Incidence Study . Diabetes 1998;47:1786-92.

36.

Culleton BF , Larson MG , Parfrey PS , Kannel WB , Levy D. Proteinuria as a risk factor for cardiovascular disease and mortality in older people: Prospective Study . Am J Med 2000;109:1-8.

37.

Gerstein HC , Mann JF , Yi QL et al. for the HOPE Study Investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and non-diabetic individuals . JAMA 2001;286:421-6.

38.

Rowley KG , Iser DM , Best JD , O'Dea K. , Leonard D. , McDermott R. Albuminuria in Australian Aboriginal people: prevalence and associations with components of the metabolic syndrome . Diabetologia 2000;43: 1397403 .

39.

Stehouwer CD , Lambert J. , Donker AJ , van Hinsbergh VW Endothelial dysfunction and pathogenesis of diabetic angiopathy . Cardiovasc Res 1997;34:55-68.

40.

Morikawa A. , Watanake K. , Ishii K. A study of anionic sites in glomerular basement membrane (GBM) in the spontaneously diabetic Chinese hamsters of Asahikawa Colony (CHA) . Diabetes 1987;36 (suppl):1-106A.

41.

Hollmann J. , Schmidt A. , von Bassewitx DB , Buddecke E. Relationship of sulfated glycosaminoglycans and cholesterol content in normal and atherosclerotic human aorta . Arteriosclerosis 1989;9:154-8.

42.

Nannipieri M. , Rizzo L. , Raputano A. , Pilo A. , Penno G. , Navalesi R. Increased transcapillary escape rate of albumin in microalbuminuric type 2 diabetic patients . Diabetes Care 1995;18:1-9.

43.

Nelson RG , Bennett PH , Beck GJ et al. for the Diabetic Renal Disease Study : Development and progression of renal disease in Pima Indians with non-insulin-dependent diabetes mellitus . New Engl J Med 1996; 335:1636-42.

44.

Pavkov ME , Sievers ML , Knowler WC , Bennett PH , Nelson RG An explanation for the increase in heart disease mortality rates in diabetic Pima Indians: effect of renal replacement therapy . Diabetes Care 2004;27:1132-6.