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Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy.

Abstract：

BACKGROUND:Albuminuria is an established risk marker for both cardiovascular and renal outcomes. Albuminuria can be reduced with drugs that block the renin-angiotensin system (RAS). We questioned whether the short-term drug-induced change in albuminuria would predict the long-term cardioprotective efficacy of RAS intervention. METHODS AND RESULTS:We analyzed data from Reduction in Endpoints in Non-insulin dependent diabetes mellitus with the Angiotensin II Antagonist Losartan (RENAAL), a double-blind, randomized trial in 1513 type 2 diabetic patients with nephropathy, focusing on the relationship between the prespecified cardiovascular end point (composite) or hospitalization for heart failure and baseline or reduction in albuminuria. Patients with high baseline albuminuria (> or =3 g/g creatinine) had a 1.92-fold (95% CI, 1.54 to 2.38) higher risk for the cardiovascular end point and a 2.70-fold (95% CI, 1.94 to 3.75) higher risk for heart failure compared with patients with low albuminuria (<1.5 g/g). Among all available baseline risk markers, albuminuria was the strongest predictor of cardiovascular outcome. The association between albuminuria and cardiovascular outcome was driven by those patients who also had a renal event. Modeling of the initial 6-month change in risk parameters showed that albuminuria reduction was the only predictor for cardiovascular outcome: 18% reduction in cardiovascular risk for every 50% reduction in albuminuria and a 27% reduction in heart failure risk for every 50% reduction in albuminuria. CONCLUSIONS:Albuminuria is an important factor predicting cardiovascular risk in patients with type 2 diabetic nephropathy. Reducing albuminuria in the first 6 months appears to afford cardiovascular protection in these patients.

journal_name

Circulation

journal_title

Circulation

authors

de Zeeuw D,Remuzzi G,Parving HH,Keane WF,Zhang Z,Shahinfar S,Snapinn S,Cooper ME,Mitch WE,Brenner BM

doi

10.1161/01.CIR.0000139860.33974.28

subject

Has Abstract

pub_date

2004-08-24 00:00:00

pages

921-7

issue

eissn

0009-7322

issn

1524-4539

pii

01.CIR.0000139860.33974.28

journal_volume

110

pub_type

临床试验,杂志文章,多中心研究,随机对照试验

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Albuminuria, a therapeutic target for cardiovascular protection in type 2 diabetic patients with nephropathy.