Brigham & Women's Hospital, Boston, Massachusetts; Bristol Myers Squibb Phamaceutical Research Institute, Penington, New Jersey; Renal Division, University of Colorado, Denver, Colorado; Division of Nephrology, Rush University Medical Center, Chicago, Illinois; Nephrology Division, University of Iowa Hospitals & Clinics, Iowa; Montreal Heart Institute, Montreal, Canada; Nephrology Division, Vanderbilt Medical Center, Nashville, Tennessee; Department of Medicine, Mount Sinai School of Medicine, New York, New York; Auckland Diabetes Center, Auckland, New Zealand; Endocrinology Unit, Hospital Clinicoy Provincial, Spain; Internal Medicine Department, Hadassa University Hebrew Hospital, Israel; Nephrology Department, Hospital de Valenciennes, France; and Divisione di Nephrologie e Dialisi, Lecco, Italy

Correspondence: Dr Marc A. Pfeffer, Cardiovascular Division, Brigham & Women's Hospital, 75 Francis Street, Boston, MA 02115. E-mail: mpfeffer@rics.bwh.harvard.edu

Abstract

Predictors of cardiovascular events in patients with type 2 diabetic nephropathy and hypertension: A case for albuminuria.

Individuals with type 2 diabetes and nephropathy represent a particularly high-risk group for both adverse cardiac as well as renal events. Using the Irbesartan in Diabetic Nephropathy Trial (IDNT) cohort, our objective was to determine baseline characteristics of individuals with type 2 diabetic nephropathy and hypertension predictive for cardiac events.

IDNT identified 1715 individuals with type 2 diabetic nephropathy and hypertension having serum creatinine of 1.0 to 3.0 mg/dL and urinary albumin excretion rates 900 mg/day. A cardiovascular (CV) composite was used consisting of CV death, nonfatal MI, hospitalization for heart failure, stroke, amputation, and coronary and peripheral revascularization. Using multivariable Cox regression analysis, 41 baseline characteristics determined a priori were analyzed for their potential relationship to risk of experiencing a CV event.

Of the 1715 individuals, 518 (30.2%) had at least one of the CV composite end points. Older age, male gender, longer duration of diabetes, history of cardiovascular disease, history of CHF, high urinary albumin:creatinine ratio, and low serum albumin were strong predictors for CV events; of these, prior history of CVD (RR 2.00, 95% CI 1.63–2.45; P < 0.0001) and high urinary albumin:creatinine ratio (RR 1.29 per natural log unit, 95% CI 1.13–1.48; P=0.0002) at baseline were highly predictive for cardiovascular events.

In conclusion, among individuals with hypertension and diabetic nephropathy, both the degree of albuminuria and lower serum albumin levels provide additional prognostic information concerning cardiovascular risk, in addition to traditional coronary risk factors.