Angiotensinogen and Risk of Stroke Events in Patients with Type 2 Diabetes Mellitus

Background: Activation of the renin-angiotensin system (RAS) in diabetic patients is a vital pathophysiological mechanism of cardiovascular complications. Aim: We aimed to assess whether serum and urinary angiotensinogen levels could predict the risk of stroke events in patients with type 2 diabetes. Methods: An analysis of the relationships between serum and urinary angiotensinogen levels at baseline and the risk of stroke events was performed in a study consisting of 467 patients with type 2 diabetes with a follow-up of 5 years. Multivariate Cox regression models were built by controlling for a large range of related risk factors. Results: Kaplan-Meier analysis showed that patients with low estimated glomerular filtration rate (eGFR) <57 mL/min/1.73 m(2) had a significantly higher risk of stroke events than those with high eGFRs (>= 57 mL/min/1.73 m(2), P=0.040). Our results suggested that urinary angiotensinogen levels (HR=2.74, 95% CI 1.50-5.88, P=<0.001), but not serum angiotensinogen levels (HR=1.42, 95% CI 0.95-2.65, P=0.071), were independent predictors of the risk of stroke events in patients with type 2 diabetes after adjusting for confounding factors. Similarly, sensitivity analysis also suggested that higher urinary angiotensinogen levels still contributed to an increased risk of stroke events (HR=2.71, 95% CI 1.48-5.82, P<0.001) but not serum angiotensinogen levels (HR=1.37, 95% CI 0.89-2.21, P=0.104). Importantly, we found that significant associations only existed in patients with eGFRs<60 mL/min/1.73 m(2) (HR=2.78, 95% CI 1.59-6.30, P<0.001) but not in patients with eGFRs >= 60 mL/min/1.73 m(2) (HR=1.39, 95% CI 0.95-3.53, P=0.054). Conclusion: The study suggested that elevated urinary angiotensinogen levels were correlated with a higher risk of stroke events in patients with type 2 diabetes mellitus.

Automated summary

The study found that elevated urinary angiotensinogen levels were associated with a higher risk of stroke events in patients with type 2 diabetes mellitus. Serum angiotensinogen levels, on the other hand, were not significantly associated with the risk. Furthermore, this association was only observed in patients with an estimated glomerular filtration rate (eGFR) below 60 mL/min/1.73 m².