ASSESSMENT OF URINARY ALBUMIN-TO-CREATININE RATIO WITH ENDOTHELIAL, INFLAMMATORY AND CARDIOMETABOLIC BIOMARKERS IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND CORONARY ARTERY DISEASE

Abstract

Background: Type 2 diabetes mellitus (T2DM) and coronary artery disease (CAD) are closely interconnected disorders associated with chronic hyperglycaemia, systemic inflammation, endothelial dysfunction and progressive renal injury. Although urinary albumin-to-creatinine ratio (UACR) is an established marker of diabetic kidney disease, its relationship with endothelial, inflammatory and cardiometabolic biomarkers in patients with concomitant T2DM and CAD remains inadequately characterized. Objective: To evaluate UACR in relation to endothelial, inflammatory and cardiometabolic biomarkers in patients with T2DM, CAD and concomitant T2DM with CAD, and to determine their integrated role in assessing cardiorenal risk. Materials and Methods: This hospital-based cross-sectional observational study included 300 participants (30–75 years), divided into four groups (n=75 each): healthy controls, T2DM, CAD and T2DM with CAD. Fasting plasma glucose, HbA1c, serum nitrite, high-sensitivity C-reactive protein (hs-CRP), lipid profile, urinary albumin, urinary creatinine and UACR were measured using standard laboratory methods. The Atherogenic Index of Plasma (AIP) and non-HDL cholesterol were calculated. Group comparisons were performed using one-way ANOVA, and Pearson's correlation analysis was used to evaluate associations between UACR and selected biomarkers. Results: Patients with concomitant T2DM and CAD demonstrated the highest fasting plasma glucose (269.4±25.8 mg/dL), hs-CRP (11.01±1.30 mg/L), UACR (31.21±6.4 mg/g), total cholesterol (238.2±15.4 mg/dL), LDL-C (160.28±13.5 mg/dL), non-HDL-C (200.60±31.6 mg/dL) and AIP (0.72±0.02), together with the lowest serum nitrite concentration (12.46±2.13 µmol/L) (p<0.01 for all). UACR showed significant positive correlations with HbA1c (r=0.61), AIP (r=0.64) and hs-CRP (r=0.76), and a significant negative correlation with serum nitrite (r=−0.71) (p<0.01 for all), indicating a close association between renal injury, metabolic dysregulation, inflammation and endothelial dysfunction. Conclusion: The coexistence of T2DM and CAD is associated with marked deterioration in metabolic, inflammatory, endothelial and renal biomarkers, reflecting progressive cardiorenal injury. The novelty of the present study lies in the integrated evaluation of UACR together with serum nitrite, hs-CRP, AIP and conventional cardiometabolic biomarkers within a single cohort, demonstrating that these complementary biomarkers collectively provide a more comprehensive assessment of cardiorenal risk than any individual marker alone. This multimarker approach may improve early risk stratification and facilitate timely preventive and therapeutic interventions in patients with T2DM and CAD.