COHORT STUDY OF PREDICTIVE VALUE OF URINARY ALBUMIN EXCRETION FOR ATHEROSCLEROTIC VASCULAR-DISEASE IN PATIENTS WITH INSULIN-DEPENDENT DIABETES

Objective-To examine whether slightly elevated urinary albumin excreti on precedes development of atherosclerotic vascular disease in patient s with insulin dependent diabetes independently of conventional athero genic risk factors and of diabetic nephropathy. Design-Cohort study wi th 11 year follow up. Setting-Diabetes centre in Denmark. Subjects-259 patients aged 19-51 with insulin dependent diabetes of 6-34 years' du ration and without atherosclerotic vascular disease or diabetic nephro pathy at baseline. Main outcome measures-Baseline variables: urinary a lbumin excretion, blood pressure, smoking habits, and serum concentrat ions of total cholesterol, high density lipoprotein cholesterol, siali c acid, and von Willebrand factor. End point: atherosclerotic vascular disease assessed by death certificates, mailed questionnaires, and ho spital records. Results-Thirty patients developed atherosclerotic vasc ular disease during follow up of 2457 person years. Elevated urinary a lbumin excretion was significantly predictive of atherosclerotic vascu lar disease (hazard ratio 1.06 (95% confidence interval 1.02 to 1.18) per 5 mg increase in 24 hour urinary albumin excretion, P=0.002). Pred ictive effect was independent of age; sex; blood pressure; smoking; se rum concentrations of total cholesterol, high density lipoprotein chol esterol, sialic acid, and von Willebrand factor; level of haemoglobin A(1c); insulin dose; duration of diabetes; and diabetic nephropathy (h azard ratio 1.04 (1.01 to 1.08) per 5 mg increase in 24 hour urinary a lbumin excretion, P=0.03). Conclusion-Slightly elevated urinary albumi n excretion independently predicted atherosclerotic vascular disease i n patients with insulin dependent diabetes.