Cardiovascular Autonomic Function Is Associated With ( Micro-) Albuminuria in Elderly Caucasian Subjects With Impaired Glucose Tolerance or Type 2 Diabetes

1369 Increased urinary albumin excretion is a strong predictor of cardiovascular disease and mortality in patients with type 2 diabetes as well as in nondiabetic subjects. The pathophysiological explanation for this association is not entirely clear, but the risk marker albuminuria has been associated with the presence of several cardiovascular risk factors, including hypertension, dyslipidemia, poor glycemic control, a prothrombotic state, and generalized endothelial dysfunction (1). Cardiovascular autonomic neuropathy is also strongly related to cardiovascular mortality in type 2 diabetes (2,3). Several studies have suggested that impaired cardiovascular autonomic function and increased urinary albumin excretion are related in patients with diabetes (4–8). Most of these studies have been done in type 1 diabetes. Similar studies in type 2 diabetes were relatively small or did not include subjects with normal glucose tolerance (NGT) and impaired glucose tolerance (IGT) for comparison with subjects with type 2 diabetes (9–14). In the present study, we investigated the relationship between cardiovascular autonomic function and albuminuria by using data from a large population-based study including subjects with NGT and IGT and type 2 diabetes. We were specifically interested in determining whether autonomic cardiovascular function is related to albuminuria independently of other factors that are known to be associated with albuminuria, including glucose intolerance and hypertension.