Low-Grade Albuminuria Is Associated with Carotid Intima-Media Thickness in Chinese Type 2 Diabetic Patients

Context: Low-grade albuminuria was reported to be associated with cardiovascular risk factors. Our present study showed a significant association between low-grade urinary albumin-to-creatinine ratio (ACR) and elevated carotid intima-media thickness (CIMT) in type 2 diabetic patients. Objective: The objective of this study is to evaluate the association between low-grade albuminuria and CIMT in type 2 diabetic patients. Design, Setting, Participants, and Measures: A cross-sectional study was performed in 760 type 2 diabetic patients (age range, 29-76 yr) with normoalbuminuria from Shanghai, China. A first-voided early morning spot urine sample was obtained for urinary albumin and creatinine measurements. CIMT was measured using high-resolution B-mode ultrasonography. Results: CIMT, as well as body mass index, glycated hemoglobin A1c, systolic and diastolic blood pressure, and serum triglycerides, progressively increased across the sex-specific quartiles of ACR (all P < 0.05). Compared with the patients in the lowest quartile, those in the third and the highest quartiles had significantly higher levels of CIMT (0.87 and 0.91 vs. 0.79 mm, P = 0.0025 and <0.0001, respectively). A fully adjusted logistic regression analysis revealed that compared with the patients in the lowest quartile of ACR, those in the third and the highest quartiles had 1.98- to 2.76-fold increased risk of elevated CIMT. Conclusions: In type 2 diabetic patients, slightly elevated ACR level, which was below the current cutoff point of microalbuminuria, was associated with higher CIMT after adjustments of conventional cardiovascular risk factors. The results implied that low-grade albuminuria might be an early marker for the detection of cardiovascular disease in type 2 diabetic patients. (J Clin Endocrinol Metab 95: 5122-5128, 2010)