{"id":"e95ce330e926","type":"article","url":"https://hartvaat.nl/2018/02/01/cv-uitkomsten-naar-albumin-en-nierziekte-bij-diabetes-type-2-met-hoog-cv-risico/","title":"CV-uitkomsten naar albumin en nierziekte bij diabetes type 2 met hoog CV-risico","title_en":"Cardiovascular Outcomes According to Urinary Albumin and Kidney Disease in Patients With Type 2 Diabetes at High Cardiovascular Risk: Observations From the SAVOR-TIMI 53 Trial.","category":"hartfalen","category_label":"Hartfalen","professions":["cardioloog","internist"],"tags":["diabetes-en-hart","diabetes-type-2","slaapapneu","soul-trial"],"journal":"JAMA cardiology","doi":"10.1001/jamacardio.2017.4228","source_url":"https://doi.org/10.1001/jamacardio.2017.4228","authors":["Benjamin M Scirica","Ofri Mosenzon","Deepak L Bhatt","Jacob A Udell","Ph Gabriel Steg","Darren K McGuire","KyungAh Im","Estella Kanevsky","Christina Stahre","Mikaela Sjöstrand","Itamar Raz","Eugene Braunwald"],"significance":6,"published":"2018-02-01","source_date":"2018-02-01","image":"","kennis":[],"congress":"","summary_en":"This analysis showed that urinary albumin levels and kidney disease status modify cardiovascular outcomes in high-risk type 2 diabetes patients, supporting routine albuminuria screening for comprehensive cardiorenal risk assessment.","created":"2026-07-03T10:27:08Z","updated":"2026-07-03T13:26:24Z","licence":"Citeer vrij, met bronvermelding en een link naar hartvaat.nl (de url van het record). Samenvattingen zijn redactioneel werk van HartVaat; de oorspronkelijke publicaties blijven van hun uitgevers (doi). Geen medisch advies.","body_markdown":"JAMA Cardiology analyse naar cardiovasculaire uitkomsten gestratificeerd naar albuminurie en nierziekte bij hoogrisico diabetes type 2.","abstract_original":"IMPORTANCE: An elevated level of urinary albumin to creatinine ratio (UACR) is a marker of renal dysfunction and predictor of kidney failure/death in patients with type 2 diabetes. The prognostic use of UACR in established cardiac biomarkers is not well described. OBJECTIVE: To evaluate whether UACR offers incremental prognostic benefit beyond risk factors and established plasma cardiovascular biomarkers. DESIGN, SETTING, AND PARTICIPANTS: The Saxagliptin Assessment of Vascular Outcomes Recorded in Patients With Diabetes Mellitus-Thrombolysis in Myocardial Infarction (SAVOR-TIMI) 53 study was performed from May 2010 to May 2013 and evaluated the safety of saxagliptin vs placebo in patients with type 2 diabetes with overt cardiovascular disease or multiple risk factors. Median follow-up was 2.1 years (interquartile range, 1.8-2.3 years). INTERVENTIONS: Patients were randomized to saxagliptin vs placebo plus standard care. MAIN OUTCOMES AND MEASURES: Baseline UACR was measured in 15 760 patients (95.6% of the trial population) and categorized into thresholds. RESULTS: Of 15 760 patients, 5205 were female (33.0%). The distribution of UARC categories were: 5805 patients (36.8%) less than 10 mg/g, 3891 patients (24.7%) at 10 to 30 mg/g, 4426 patients (28.1%) at 30 to 300 mg/g, and 1638 patients (10.4%) at more than 300 mg/g. When evaluated without cardiac biomarkers, there was a stepwise increase with each higher UACR category in the incidence of the primary composite end point (cardiovascular death, myocardial infarction, or ischemic stroke) (3.9%, 6.9%, 9.2%, and 14.3%); cardiovascular death (1.4%, 2.6%, 4.1%, and 6.9%); and hospitalization for heart failure (1.5%, 2.5%, 4.0%, and 8.3%) (adjusted P < .001 for trend). The net reclassification improvement at the event rate for each end point was 0.081 (95% CI, 0.025 to 0.161), 0.129 (95% CI, 0.029 to 0.202), and 0.056 (95% CI, -0.005 to 0.141), respectively. The stepwise increased cardiovascular risk associated with a UACR of more than 10 mg/g was also present within each chronic kidney disease category. The UACR was associated with outcomes after including cardiac biomarkers. However, the improvement in discrimination and reclassification was attenuated; net reclassification improvement at the event rate was 0.022 (95% CI, -0.022 to 0.067), -0.008 (-0.034 to 0.053), and 0.043 (-0.030 to 0.052) for the primary end point, cardiovascular death, and hospitalization for heart failure, respectively. CONCLUSIONS AND RELEVANCE: In patients with type 2 diabetes, UACR was independently associated with increased risk for a spectrum of adverse cardiovascular outcomes. However, the incremental cardiovascular prognostic value of UACR was minimal when evaluated together with contemporary cardiac biomarkers. TRIAL REGISTRATION: clinicaltrials.gov Identifier: NCT01107886."}