Urinary N-Acetyl-β-d-Glucosaminidase (NAG) Levels and Risk of Cardiovascular Events in Diabetic Patients

Background: Cardiovascular diseases (CVDs) have a high incidence rate in population with diabetic patients. Studies on the association between urinary N-acetyl-beta-d-glucosaminidase (NAG) levels, the biomarker of renal tubular damage, with cardiovascular (CV) events diabetic patients was still few. Methods: The relationship between urinary NAG levels and CV events was analyzed in a prospective cohort including 357 patients with type 2 diabetes mellitus at a follow-up of 5 years. Results: Twenty-six (7.3%) patients have CV events. Kaplan-Meier analysis suggested that diabetic patients with urine NAG levels >= 37.5 IU/L had a higher rate of CV events than those with urine NAG levels <37.5 IU/L (Log rank test, P = 0.021). Cox analysis revealed that elevated urine NAG levels significantly contributed to increased risk of CV events (HR = 1.43, 95% CI 1.23-1.93, P < 0.001) after adjusting for clinical confounding factors. Interestingly, we also found that abnormal renal function has an effect modification on the association between urine NAG levels and CV events. ROC-AUC analysis suggested that the urine NAG (AUC = 0.81, P < 0.001) had a better predictive value than eGFR (AUC = 0.74, P = 0.012). Conclusion: Elevated urine NAG levels are associated with higher risk of CV events in patients with type 2 diabetes. These results might further suggested that urinary NAG is a value urinary biomarker for early detecting CV events among diabetic patients.

Automated summary

Elevated urine NAG levels are associated with higher risk of cardiovascular events in patients with type 2 diabetes. Urinary NAG may be a valuable urine biomarker for early detection of cardiovascular events among diabetic patients.