Elevated Brachial-Ankle Pulse Wave Velocity Is Independently Associated with Microalbuminuria in a Rural Population

Abstract

Microalbuminuria is a marker of generalized endothelial dysfunction resulting from arterial stiffness or insulin resistance, and brachial-ankle pulse wave velocity (baPWV) is a good measure of arterial stiffness. We aimed to investigate whether elevated baPWV is independently associated with microalbuminuria. This study included 1,648 individuals aged over 40 who participated in the baseline Multi-Rural Cohort Study conducted in Korean rural communities between 2005 and 2006. Participants were classified into less than 30 mg/g as normoalbuminuria or 30-300 mg/g as microalbuminuriausing urinary albumin creatinine ratio (UACR). The median and Q1-Q3 baPWV values were significantly higher in the microalbuminuric group both in men (1,538, 1,370-1,777 cm/s vs. 1,776, 1,552-2,027 cm/s, P < 0.001) and women (1,461, 1,271-1,687 cm/s vs. 1,645, 1,473-1,915 cm/s, P < 0.001). BaPWV was independently associated with microalbuminuria in both genders after adjusting for pulse rate; fasting blood glucose; triglyceride; homeostatic model assessment insulin resistance (HOMAIR) and, history of hypertension and diabetes. Fasting blood sugar and HOMAIR were judged as having nothing to do with multicolinearity (r = 0.532, P < 0.001). Elevated baPWV was independently associated with microalbuminuria regardless of insulin resistance among rural subjects over 40 yr.Graphical Abstract

Brachial–ankle pulse wave velocity is independently associated with urine albumin-to-creatinine ratio in a Chinese community-based cohort

“…In addition, the prevalences of hypertension (65.8% in the ABI < 0.9 group and 54.1% in the ABI ≥ 0.9 group) and diabetes mellitus (28.9% in the ABI < 0.9 group and 18.3% in the ABI > 0.9 group) were also higher than in our study, which may also contribute to stiffer arteries. In a study conducted in Korean rural communities with participants aged over 40 years, the median baPWV was 1515 cm/s (interquartile range 1325-1764 cm/s), which is similar to that in the present study [23]. Our findings were consistent with those of another community-based cross-sectional study of 2127 community residents of Han ethnicity in Beijing, China aged 60-95 years [22].…”

“…In a community-based cross-sectional study of people of Han ethnicity aged 60-95 years in Beijing, China, the overall rate of pathological albuminuria was 13.16%; this was higher than the 8.25% reported in our study, which can be attributed to the relatively old age of the study population [22]. In another study of a rural population aged over 40 years in Korea, the prevalence of microalbuminuria was 9.9% [23].…”

“…Although both studies were conducted with Chinese community-based cohorts, the previous study was conducted with an elderly population and excluded residents with histories of CVD and stroke, both of which may contribute to the higher observed baPWV. In a previous Korean study of a rural population of 1648 participants aged over 40 years [23], the baPWV was proven to be independently associated with microalbuminuria; after adjusting for several variables, log(baPWV) was still an independent risk factor for microalbuminuria in both men (OR 15.813, 95% CI 2.629-95.119) and women (OR 5.399, 95% CI 1.157-25.205). Unlike our study, this study excluded participants with CVD and stroke and those with macroalbuminuria and overt albuminuria.…”

Association between Brachial-Ankle Pulse Wave Velocity and Microalbuminuria and to Predict the Risk for the Development of Microalbuminuria Using Brachial-Ankle Pulse Wave Velocity Measurement in Type 2 Diabetes Mellitus Patients

“…More importantly, receiver operating characteristic (ROC) curve analysis revealed that the optimum baPWV cut-off for predicting the presence of MAU (20 µg/min) in Type 2 DM was 1700 cm/sec. This study showed that 21.9% of the 424 Type 2 DM patients included had MAU, which is much higher than the rates found in previous Korean studies [26,31]. However, previous Korean studies were conducted on healthy subjects.…”

“…Several authors have concluded baPWV provides a useful means of quantitatively assessing cardiovascular events and diabetic complications [21][22][23], and cross-sectional and longitudinal studies have shown baPWV is independently associated with MAU [24][25][26]. Others have suggested baPWV cut-off values for the prediction of mortality [18] and the development of cardiovascular illnesses [27].…”