The impact of microalbuminuria and macroalbuminuria on mortality was e
valuated prospectively in 328 Caucasian patients with non-insulin-depe
ndent diabetes mellitus (NIDDM) followed for 5 years, One hundred nine
ty-one (109 men and 82 women) patients with normoalbuminuria (albumin
excretion rate [AER] <30 mg/24 h), 86 (50 men and 36 women) patients w
ith microalbuminuria (AER 30-299 mg/24 h), and 51 (43 men and 8 women)
patients with macroalbuminuria (AER greater than or equal to 300 mg/2
4 h) <66 years old at entry were followed from 1987 until death or unt
il 1 January 1993, Mean age at entry was 54 (SD 9) years, In January 1
993, 8% of patients with normoalbuminuria, 20% of patients with microa
lbuminuria, and 35% of patients with macroalbuminuria had died (predom
inantly from cardiovascular disease) (P < 0.01 [normoalbuminuria versu
s micro- and macroalbuminuria] and P < 0.05 [microalbuminuria versus m
acroalbuminuria]), Cox multiple regression analysis revealed significa
nt predictors of all-cause mortality to be preexisting coronary heart
disease (relative risk [95% confidence interval]), 2.9 (1.6-5.1); log(
10)AER (factor 10), 1.9 (1.4-2.6); HbA(1c) level (%), 1.2 (1.0-1.4); a
nd age (years), 1.08 (1.03-1.13), Significant predictors of cardiovasc
ular mortality included preexisting coronary heart disease, 6.1 (2.8-1
3.5); macroalbuminuria, 2.5 (1.1-5.8); HbA(1c) level(%), 1.3 (1.1-1.6)
; and systolic blood pressure (10 mmHg), 1.2 (1.0-1.4). Univariate Cox
survival analysis in the normoalbuminuric group revealed that AER abo
ve the median of 8 mg/24 h was associated with an increased all-cause
mortality risk of 2.7 (0.93-7.69) (P = 0.07), We conclude that abnorma
lly elevated urinary albumin excretion and poor glycemic control indic
ate a substantially increased all-cause, mainly cardiovascular, mortal
ity risk in NIDDM patients.