Association of Albuminuria With Cardiac Dysfunction in US Hispanics/Latinos

Abstract

Higher urine albumin-to-creatinine ratio (UACR) has been associated with cardiac dysfunction in the general population. We assessed the association of UACR with cardiac structure and function in the Echocardiographic Study of Latinos (Echo-SOL), an ancillary study of the Hispanic Community Health Study/Study of Latinos (HCHS/SOL) across 4 U.S. sites. Echo-SOL participants underwent standard 2-dimensional echocardiography, including speckle-tracking strain analysis. UACR was categorized as normal and high-normal (based on the midpoint of values below microalbuminuria), microalbuminuria (≥17 mg/g for men; ≥25 mg/g for women), and macroalbuminuria (≥250 mg/g; ≥355 mg/g). Simultaneous assessments were made of left ventricular (LV) mass index and hypertrophy, and measures of LV systolic and diastolic dysfunction. We assessed the association of UACR with subclinical cardiac measures, adjusting for sociodemographic and cardiometabolic factors. Among 1,815 participants (median age 54, female 65%), 42% had normal UACR, 43% high-normal UACR, 13% microalbuminuria, and 2% macroalbuminuria. Prevalence of LV hypertrophy was 13%, LV systolic dysfunction (ejection fraction <50%) 3%, and diastolic dysfunction 53%. After covariate adjustment, both micro- and macroalbuminuria were significantly associated with a two-fold increase in LV hypertrophy. Microalbuminuria but not macroalbuminuria was associated with worse global longitudinal strain. Elevated UACR, even at high-normal levels, was significantly associated with greater diastolic dysfunction. In conclusion, elevated UACR was associated with LV hypertrophy and diastolic dysfunction in the largest known population sample of U.S. Hispanic/Latinos. Screening and detection of even high-normal UACR could be of value to guide CVD prevention efforts among Hispanic/Latino Americans.

Relationship between high‐normal albuminuria and arterial stiffness in Chinese population

“…Microalbuminuria is strongly associated with the morbidity and mortality of cardiovascular diseases in hypertensives, diabetics, and general population 1‐3 . Epidemiological data suggested that UACR levels are low in the general population, usually below the diagnostic criteria for microalbuminuria, 20 which was consistent with our data, only a small percentage of subjects were diagnosed with microalbuminuria (12.06%) or macroalbuminuria (1.49%). High‐normal albuminuria, which was below the diagnostic criteria for microalbuminuria, was reported to be capable of predicting the morbidity and mortality of cardiovascular diseases 7 , and UACR level was proved to be related with pulse wave velocity as well 13,14 .…”

Association of urine albumin‐to‐creatinine ratio with subclinical systolic dysfunction in hypertensive patients but not normotensive subjects: Danyang study

“…There are conflicting findings with respect to the association between UACR and diastolic function. 13,14 The HyperGEN Study only found significant association between UACR and E/e′, 13 while Echo-SOL Study demonstrated significant associations of UACR with E/e and e′, respectively. 14 Our findings should be interpreted within the context of its strengths and limitations.…”

“…Previous studies investigated the association of albuminuria with subclinical systolic and diastolic function in the general population 13,14 and in diabetic patients. 15 However, the findings regarding association of albuminuria with GLS were not consistent.…”

“…15 However, the findings regarding association of albuminuria with GLS were not consistent. [13][14][15] Katz et al 13 demonstrated that higher UACR was associated with reduced GLS in the general population, but not in normotensive patients, indicating that this significant association might present in hypertensive patients. The present study therefore is aimed to examine the association between UACR and subclinical cardiac function by using comprehensive echocardiography in a larger sample of Chinese population, particularly in examining whether the association only present in hypertensive patients but not in normotensive patients.…”

Evaluation of Left Ventricular Function in Type-2 Diabetes Mellitus with Microalbuminuria

“…Guglielmi MD et al 12 also had similar observation in their study and concluded that microalbuminuria was associated with significant changes in left ventricular morphology and more severe impairment of cardiac function. Hanna DB et al 13 in their study found that higher urine albumin-to-creatinine ratio (UACR) was associated with cardiac dysfunction in the general population.…”