Positive Correlation between Microalbuminuria and Severity of Coronary Artery Stenosis in Patients with Type 2 Diabetes Mellitus
Abstract
Diabetes mellitus (DM) is the most prevalent metabolic disease worldwide and is associated with coronary artery disease (CAD). Therefore it is very important to find a clue to diagnose the presence of CAD as early as possible in DM patients. The aim of this study was to find any correlation between microalbuminuria (MAU) and the severity of CAD in patients with DM type 2. This was a cross sectional study that included 77 DM type 2 patients with suspected CAD that all of whom were performed coronary angiography in our hospital (from 2010 to 2011). Patients were divided into two groups, the case group (group 1) that includes patients with MAU and the control group (group 2) that include patients without MAU. Severity of CAD was estimated by using Gensini score and MAU was defined as the ratio of urine albumin to urine creatinine. Of 77 patients forty three (55.8%) were female, mean ± SD of their ages was 55.8 ± 10.3 and sixteen (21%) of them had MAU. Gensini score of case group was significantly higher than control group (94.94 ± 12 versus 33.25 ± 25.4, P<0.001). The linear regression analysis revealed urinary albumin to creatinine ratio (UA/CR) as an independent predictor for the severity of CAD (P<0.001). Based on the ROC curve, 10.25 was the best albumin level cut off point for differentiating Gensini score over and below 70. Area under curve was 0.9; sensitivity and specificity were 72% and 80%, respectively (P<0.001). According to this study, in patients with DM type2, MAU is an independent predictor of severity of coronary artery stenosis and reveals a positive correlation between MAU and the Gensini score.
Wild S, Roglic G, Green A, Sicree R King H. Global prevalence of diabetes: estimates for the year 2000and projections for 2030. Diabetes Care 2004; 27(5):1047-53.
Panzram G. Mortality and survival in Type 2 (non-insulindependent) diabetes mellitus. Diabetologia 1987;30(3):123-31.
Pahor M, Elam MB, Garrison RJ, Kritchevsky SB,Applegate WB. Emerging noninvasive biochemical measures to predict cardiovascular risk. Archives of Internal Medicine 1999; 159(3):237-45.
Esteghamati A, Gouya MM, Abbasi M, Delavari A, Alikhani S, Alaedini F, Safaie A, Forouzanfar M, Gregg EW. Prevalence of Diabetes Mellitus and Impaired Fasting Glucose in the Adult Population of Iran: The National Survey of Risk Factors for Non-Communicable Diseases of Iran. Diabetes Care, 2007.
Stehouwer CD, Henry RM, Dekker JM, Nijpels G, Heine RJ, Bouter LM.. Microalbuminuria is associated with impaired brachial artery, flow-mediated vasodilation in elderly individuals without and with diabetes: Further evidence for a link between microalbuminuria and endothelial dysfunction - The Hoorn Study. Kidney Int Suppl 2004;(92):S42-4
Quyyumi AA. Prognostic value of endothelial function. Am J Cardiol 2003 Jun 19;91(12A):19H-24H.
Adler AI, Boyko EJ, Ahroni JH, Smith DG. Lowerextremity amputation in diabetes. The independent effects of peripheral vascular disease, sensory neuropathy, and foot ulcers. Diabetes Care 1999; 22(7):1029-35
Deveci OS, Kabakci G, Tulumen E, Okutucu S, Aksoy H, Kaya EB, Canpolat U, Aytemir K, Tokgozoglu L, Oto A.. The relationship between microalbuminuria and the presence and extent of coronary atherosclerosis. Angiology 2010; 61(2):184-91.
Sukhija R, Aronow WS, Kakar P, Garza L, Sachdeva R, Sinha A, Mehta JL. Relation of microalbuminuria and coronary artery disease in patients with and without diabetes mellitus. Am J Cardiol 2006; 98(3):279-81.
Deckert T, Kofoed-Enevoldsen A, Nørgaard K, Borch- Johnsen K, Feldt-Rasmussen B, Jensen T. Microalbuminuria: Implications for micro- and macrovascular disease. Diabetes Care 1992;15(9):1181-91.
Ioannidis G, Peppa M, Rontogianni P, Callifronas M, Papadimitriou C, Chrysanthopoulou G, Anthopoulos L, Kesse M, Thalassinos N. The concurrence of microalbuminuria and retinopathy with cardiovascular risk factors; reliable predictors of asymptomatic coronaryartery disease in type 2 diabetes. Hormones (Athens) 2004; 3(3):198-203.
Sniderman A, Michel C, Racine N. Heart disease in patients with diabetes mellitus. Journal of Clinical Epidemiology 1992; 45(12);1357-70.
Kuulasmaa K, Tunstall-Pedoe H, Dobson A, Fortmann S,,Sans S, Tolonen H, Evans A, Ferrario M, Tuomilehto J. Estimation of contribution of changes in classic risk factorsto trends in coronary-event rates across the WHO MONICA Project populations. Lancet 2000;355(9205):675-87.
Ramirez G, Bugni W, Farber SM, Curry AJ. Incidence of renal artery stenosis in a population having cardiac catheterization. South Med J 1987; 80(6):734-7.
Jean WJ, Al-Bitar I, Zwicke DL, Port SC, Schmidt DH, Bajwa TK. High incidence of renal artery stenosis in patients with coronary artery disease. Cathet Cardiovasc Diagn 1994; 32(1):8-10.
Choi EY, Kwon HM, Yoon YW, Kim D, Kim HS. Assessment of extent of myocardial ischemia in patients with non-ST elevation acute coronary syndrome using serum B - type natriuretic peptide level. Yonsei Medical J 2004; 45(2) pp.255-262. Available at: http://www.eymj.org/Synapse/Data/PDFData/0069YMJ/y,mj-45-255.pdf.
Sherif A El, Khaled M, Ibrahim A, and. Elhattab M M. Association Of Glycosylated Hemoglobin Level And Microalbuminuria With The Severity Of Coronary Artery Disease. Journal of American Science, 2011;7(12)
Guo L, Cheng Y, Wang X, Pan Q, Li H, Zhang L, Wang Y. Association between microalbuminuria and cardiovascular disease in type 2 diabetes mellitus of the Beijing Han nationality.Acta Diabetol 2010; 49 Suppl 1:S65-71.
Lekatsas I, Kranidis A, Ioannidis G, Kalofoutis C, Tavernarakis A, Thalassinos N, Kalofoutis A, Anthopoulos L, Koulouris S. Comparison of the extent and severity of coronary artery disease in patients with acute myocardial infarction with and without microalbuminuria. The American Journal of Cardiology 2004;94(3),334–7.
Luo BJ, Yu DQ, Chen JY, Zhou YL, Tan N. Correlation of microalbuminuria and fibrinogen to the severity of coronary artery lesions in patients with metabolic syndrome. Nan Fang Yi Ke Da Xue Xue Bao 2010;30(11):2459-62.
Files | ||
Issue | Vol 51, No 4 (2013) | |
Section | Original Article(s) | |
Keywords | ||
Coronary artery stenosis Microalbuminuria Diabetes mellitus type 2 Gensini score |
Rights and permissions | |
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License. |