Purpose: Microalbuminuria, defined as urine albumin-to-creatinine ratio of 0.03 to 0.299 mg/mg, is a major risk factor for cardiovascular disease. Several genetic epidemiological studies have established that microalbuminuria clusters in families, suggesting a genetic predisposition. Method: We estimated heritability of microalbuminuria and performed a genome-wide linkage analysis to identify chromosomal regions influencing urine albumin-tocreatinine ratio in 486 Mexican Americans from 26 multiplex families. Results: Significant heritability was demonstrated for urine albumin-to-creatinine ratio (h 2 ϭ 24%, P Ͻ 0.003) after accounting for age, sex, body mass index, triglycerides, and hypertension. Genome scan revealed significant evidence of linkage of urine albumin-tocreatinine ratio to a region on chromosome 20q12 (LOD score of 3.5, P Ͻ 0.001) near marker D20S481. This region also exhibited a LOD score of 2.8 with diabetes status as a covariate and 3.0 with hypertension status as a covariate suggesting that the effect of this locus on urine albumin-to-creatinine ratio is largely independent of diabetes and hypertension.
Key Words: Microalbuminuria, albumin to creatinine ratio, cardiovascular diseases, Mexican Americans, family genetic studyMicroalbuminuria is the excretion of low but abnormal levels (Ն30 mg/day) of albumin in the urine. Microalbuminuria is defined as albumin-to-creatinine ratio of 0.03 to 0.299 mg/mg on a random sample of urine. 1 Microalbuminuria is an important independent risk factor for the development of cardiovascular disease (CVD). 2 Several studies have shown that microalbuminuria, in addition to being an independent CVD risk factor, is a significant predictor of CVD, and all-cause mortality in the diabetic and nondiabetic general population. [3][4][5] This predictive effect of microalbuminuria is independent of other known CVD risk factors such as being overweight, hypertension, hypercholesterolemia, and smoking. 6 Results from the Third Copenhagen City Heart Study indicate that even very low levels of microalbuminuria are associated with increased independent risk of CVD. 5 The European Prospective Investigation into Cancer in Norfolk study examined the relationship between microalbuminuria and the incidence of CVD in individuals aged 40 to 79 years without prevalent baseline CVD. Among the participants with baseline CVD, the independent risk of all-cause mortality associated with microalbuminuria increased by 60%, when compared with normoalbuminuric participants, 7 confirming that microalbuminuria is of prognostic value in patients with established CVD. 8 Similarly, results from the San Antonio Heart Study showed that normotensive subjects with microalbuminuria had significantly higher triglyceride concentrations and insulin levels than normotensive Mexican American and non-Hispanic white subjects without microalbuminuria, suggesting that an increased atherogenic risk factor pattern exists even in normotensive subjects with microalbuminuria. 9 In addition, population-based observat...