Urine Test May Reveal 4x Risk of Cardiovascular Death in Type 2 Diabetes Patients

by Bayer, reviewed and edited by Ian J. Neeland, MD, FAHA, FACCMay 28, 2025 

Urine Test May Reveal 4x Risk of Cardiovascular Death in Type 2 Diabetes Patients | MedPage Today

People living with type 2 diabetes (T2D) who also have albuminuria are up to four timesopens in a new tab or window more likely to die from a cardiovascular (CV) event, five times more likely to be hospitalized for heart failure, and three times more likely to have a heart attack compared to people with T2D alone. In fact, a 2025 prospective analysis in Austrian patients stated that albuminuria may be on paropens in a new tab or window with the same risk as a prior heart attack when it comes to predicting a future heart attack.

Even though albuminuria can be detected through a common and inexpensive urine test — urine albumin-to-creatinine ratio (UACR) — we aren’t screening for it as often as we should or treating it adequately.

According to the American Diabetes Association (ADA)opens in a new tab or window and the American Heart Association (AHA)opens in a new tab or window, everyone with T2D should have their UACR tested as soon as they’re diagnosed and then at least once a year after that to screen for kidney disease.

If UACR is ≥30 mg/g for at least three months, the patient is considered to have albuminuriaopens in a new tab or window, which is not only important for identifying CV risk but also an early sign of chronic kidney disease (CKD). Once a patient is diagnosed with albuminuria, UACR testing frequency should increase.

In reality, only about halfopens in a new tab or window of T2D patients have their UACR checked once a year. What’s more, those with persistent albuminuria often need to receive timely treatment to lower their CV risk. Now, with one in three T2D patients also living with cardiovascular disease, the need for timely testing and discussion is critical.

Recommendation Versus Reality

According to ADAopens in a new tab or window, UACR ≥30 mg/g should trigger immediate clinical action with an emphasis on a comprehensive approach to lower CV risk in people with T2D. Guidelines recommend considering the addition of a non-steroidal mineralocorticoid receptor antagonist, sodium-glucose cotransporter 2 inhibitor (SGLT2), and glucagon-like peptide 1 (GLP-1).

Yet, undertreatmentopens in a new tab or window leaves many patients exposed to CV complications and even CV death.

CV Risk Shows Up Early — If We Know Where to Look

CV disease is responsible for halfopens in a new tab or window of all deaths among people with T2D. As clinicians, we have the opportunity to intervene, but it’s only possible if we’re paying attention to the early warning signs and looking in the right places.

And the kidneys could hold the key.

That’s because the kidneys are a window to circulation. The glomerular filtration barrier in the kidney shares structural similarities with blood vessel walls, so damage to one often indicates damage to the other. And although kidney health is always a serious concern for people with T2D, damage to the CV system is even more dire.

In fact, a person with early-stage kidney disease is more likelyopens in a new tab or window to die of a CV event than they are to develop kidney failure.

This is a prime example of why we can’t fall into the trap of viewing organ systems in isolation. A kidney test doesn’t just have to tell us about the kidneys. Rather, it can provide clues about the health of the entire circulatory system.

How we screen matters, too. Historically, we’ve relied on estimated glomerular filtration rate (eGFR) as the primary marker for kidney health, and although eGFR is an important measure of kidney function, it doesn’t measure kidney damage.

UACR, on the other hand, estimates kidney damage. When the kidney’s glomerular filtration barrier is compromised, albumin leaks into the urine, even though kidney function may still appear normal. Many people have elevated UACR readings years beforeopens in a new tab or window their eGFR declines.

Detecting persistent UACR ≥30 is crucial for identifying CKD, which puts your patients with T2D at significant CV risk. Clinical practice guidelines recommend a comprehensive treatment approach with multiple therapeutic options to address both.

Making UACR Routine in T2D

Checking UACR isn’t complicated — it’s a urine test covered by the vast majority of insurance plans. And as a part of many standard panels from major labs, UACR testing doesn’t add any extra cost to patients. It doesn’t even require 24-hour urine collection.

UACR also independently predictsopens in a new tab or window CV events beyond traditional risk factors like high blood pressure and high cholesterol.

Yet, despite the evidence for its prognostic value and the relative ease of screening, albuminuria remains an underappreciatedopens in a new tab or window marker for CV risk, falling to the wayside for many clinicians who may think of UACR as a test solely for CKD.

Most of us wouldn’t ignore a significantly elevated LDL-cholesterol or a hemoglobin A1C level creeping above target. So why are we comfortable overlooking albuminuria — a biomarker that confers a similar level of CV risk?

We need to change the way we think about UACR. Just as an A1C >7% prompts us to intensify glycemic management, a UACR ≥30 should elevate concern for CV risk. For every patient with T2D, think beyond glucose control — assess UACR, identify CV risk early, and intervene. When detected early, UACR is modifiable, and treatment could help to reduce the risk of cardiovascular events.

If you’re not already incorporating annual UACR testing into your practice, now is the time.

Dr. Neeland is director of cardiovascular prevention and co-director of the Center for Integrated and Novel Approaches in Vascular-Metabolic Disease, and McCamon Family Chair in Cardiovascular Excellence for University Hospitals Harrington Heart & Vascular Institute, and Associate Professor of Medicine at the Case Western Reserve University School of Medicine in Cleveland, Ohio. Dr. Neeland is also a paid consultant for Bayer.