Microalbuminuria presents the same vascular risk as overt CVD in type 2 diabetes

Objectives: We attempted to assess whether microalbuminuria conferred the same cardiovascular risk as overt CVD in type 2 diabetic patients. Material and methods: A prospective cohort study including 436 type 2 diabetic patients (64.8 +/- 9.2 years old) without proteinuria, with follow-up until any cardiovascular event occurred, was performed. Patients were classified into four groups: group 0, non baseline CVD and normoalbuminuria; group 1, non baseline CVD and microalbuminuria; group 2, baseline CVD and normoalbuminuria; group 3, baseline CVD and microalburninuria. Cox's multivariate regression models were used to assess the risk ratio (RR) associated with each variable. Results: The median follow-up time was 7.6 years. Incidence rates of cardiovascular events per 1000 patient-years increased from groups 0 to 3 (23.8, 63.4, 74.1, 85.6; p < 0.0001). Multivariate RR for incident CVD in groups 1, 2 and 3 in relation to group 0 were 2.8 (95% confidence interval (CI) 1.7-4.6; p < 0.0001), 2.7 (95% CI 1.6-4.6; p < 0.0001) and 2.9 (95% CI 1.6-5.4; p = 0.001), respectively. No significant differences were seen between groups 1 and 2. Conclusions: We suggest that patients with microalburninuria are at very high vascular risk and should share the same objectives of a vascular risk-factor control as patients with overt CVD. (c) 2006 Elsevier Ireland Ltd. All rights reserved.