Low-grade albuminuria associated with brachial-ankle pulse wave velocity in young adults with type 2 diabetes mellitus in China

摘要

Background: Cardiovascular disease is prevalent in type 2 diabetics, and microalbuminuria is associated with cardiovascular disease morbidity. We aimed to investigate the potential association between low-grade albuminuria and arterial stiffness in patients with type 2 diabetes. Methods: Between 2009 and 2013, a retrospective study was performed in 578 patients with type 2 diabetes (339 male patients and 239 female patients) with normal urinary albumin-to-creatinine ratios (ACRs; <30mg/g) from Fuzhou, China. Patients were stratified into tertiles based on urinary ACR levels (lowest tertile, urinary ACR<4.8mg/g; highest tertile, urinary ACR≥20.1 mg/g). Arterial stiffness was measured via brachial-ankle pulse wave velocity. Results: Brachial-ankle pulse wave velocity, age, duration of diabetes, systolic blood pressure and pulse wave velocity progressively increased across all urinary albumin-to-creatinine ratio tertiles (p<0.05). Patients in the second and the highest tertiles had significantly elevated pulse wave velocity [114.6mm/s (95% CI=36.8-192.4) and 209.4mm/s (95% CI=131.8-286.9)], p=0.004 and 0.000] compared with those in the lowest ACR tertile. The association between ACR and elevated pulse wave velocity still persisted in patients younger than 65years of age and those with diabetes <10years, conferring 45 or 51% greater risk of elevated pulse wave velocity (OR=1.451; 95% CI=1.119-1.881; p=0.005 or OR=1.515; 95% CI=1.167-1.966; p=0.0018) with each ACR tertile increment. Each ACR tertile increment conferred 31.7% higher risk of increased pulse wave velocity (OR=1.317; 95% CI=1.004-1.729; p=0.0468). Conclusions: Patients with type 2 diabetes with urinary albumin excretion in the upper normal range were still at risk for target organ damage. Low-grade albuminuria might be an early marker for the detection of arterial stiffness in patients with type 2 diabetes, especially in younger patients with type 2 diabetes with shorter durations of disease.