Urine Albumin Excretion and Subclinical Cardiovascular Disease

Kramer, Holly; Jacobs, David R.; Bild, Diane E.; Post, Wendy S.; Saad, Mohammed F.; Detrano, Robert; Tracy, Russell P.; Cooper, Richard; Liu, Kiang

doi:10.1161/01.hyp.0000171189.48911.18

Cited by 142 publications

(121 citation statements)

References 29 publications

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“…Several studies provide evidence of increased cardiovascular morbidity and mortality at urinary albumin excretion rates below the conventional cut-off point for microalbuminuria in the general population, in addition to patients with diabetes or hypertension. [5][6][7][8][9][10] Klausen et al 5 found that a UACR value above the upper quartile, that is, 4.8 mcg min À1 , is associated with an increased risk of coronary heart disease (relative risk 2.0; 95% CI 1.4-3.0) and death (relative risk 1.9; 95% CI 1.5-2.4), independent of age, sex, renal creatinine clearance, diabetes mellitus, hypertension, and plasma lipids in non-diabetic and non-hypertensive adults. In the MONICA/KORA substudy, 10 it was noted that UACR levels of 4-10 mg g À1 may be associated with increased cardiovascular risk, considering the results of several studies, including the Framingham Heart Study, even though this level is far below the currently used threshold of 30 mg g À1 UACR.…”

Section: Discussionmentioning

confidence: 99%

“…Several studies have provided evidence of increased cardiovascular morbidity and mortality when urinary albumin excretion rates are below the currently conventional cut-off point for microalbuminuria, among the general population as well as those with diabetes or hypertension. [5][6][7][8][9][10] Although the threshold level at which microalbuminuria is predictive of cardiovascular outcomes is getting lower, there is a paucity of data showing the relationship between low-grade albuminuria and renal risk.…”

Section: Introductionmentioning

confidence: 99%

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Very low-grade albuminuria reflects susceptibility to chronic kidney disease in combination with cardiovascular risk factors

et al. 2010

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Low-grade albuminuria has been proposed as a cardiovascular risk factor that is below the conventional cut-off point for microalbuminuria, which has been previously identified as a marker for cardiovascular disease and chronic kidney disease (CKD). Metabolic syndrome has also been shown to be related with microalbuminuria and CKD. We assessed the relationship among low-grade albuminuria, CKD and metabolic syndrome among 5998 non-diabetic subjects. The subjects were divided into six groups: subjects with urine albumin-to-creatinine ratio (UACR) o30 mg g À1 were divided into five groups in accordance with their UACR values, and subjects with 30pUACR o300 mg g À1 were allocated to the microalbuminuria group. The prevalence of CKD increased in parallel with increasing UACR values and greater numbers of metabolic syndrome characteristics, which were in turn associated with a reduced UACR cut-off point for an increased prevalence of CKD. Among the subjects with metabolic syndrome, UACR values above 10.2 mg g À1 were related to increased CKD prevalence (odds ratio (OR): 2.63, 95% confidence interval (CI) 1.11-6.24), as were values of 30 mg g À1 among those with 1 or 2 components of metabolic syndrome (OR: 2.98, 95% CI 1.83-4.83); elevated UACR was not observed to increase the risk of CKD in subjects who had no components of metabolic syndrome. The cut-off point varied in subjects with various cardiovascular risk profiles such as serum uric acid level, gender or hypertension. Very low levels of albuminuria were associated with increased CKD prevalence. The UACR cut-off point for increased CKD risk varied according to the risk profile, including the number of metabolic syndrome components.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Very low-grade albuminuria reflects susceptibility to chronic kidney disease in combination with cardiovascular risk factors

et al. 2010

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“…The extent of CAC predicts the risk of CHD events. [18][19][20] Albuminuria among older (mean age 63 years) 21 but not younger adults (mean age 44 years) 22 and glomerular filtration rate (GFR) 23 are each associated with CAC presence and extent. Albuminuria is a potent predictor of future cardiovascular events, even among persons with a normal GFR.…”

Section: Introductionmentioning

confidence: 99%

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

Cassidy‐Bushrow

Bielak

Rule

et al. 2009

Journal of Women's Health

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Background: Hypertension during pregnancy (HDP) increases the risk of future coronary heart disease (CHD), but it is unknown whether this association is mediated by renal injury. Reduced renal function is both a complication of HDP and a risk factor for CHD. Methods: Logistic regression models were fit to examine the association between a history of HDP and the presence and extent of coronary artery calcification (CAC), a measure of subclinical coronary artery atherosclerosis, in 498 women from the Epidemiology of Coronary Artery Calcification Study (mean age 63.3 AE 9.3 years). Results: Fifty-two (10.4%) women reported a history of HDP. After adjusting for age at time of study participation, HDP was associated with increased serum creatinine later in life ( p ¼ 0.014). HDP was positively associated with the presence of CAC after adjusting for age at time of study participation (OR ¼ 2.7, 95% CI 1.4-5.4). This association was slightly attenuated with adjustment for body size and blood pressure (OR ¼ 2.4, 95% CI 1.2-4.9) but was not further attenuated with adjustment for serum creatinine and urinary albumin=creatinine ratio (OR ¼ 2.6, 95% CI 1.3-5.3). Results were similar for CAC extent. Conclusions: HDP may increase a woman's risk of future CHD beyond traditional risk factors and renal function. Women with a history of HDP should be monitored for potential increased risk of CHD as they age.

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“…Previous studies have shown that urinary albumin excretion reflects the presence of CVD among patients. 4 Elevated level of LDL signifies the severity of acute coronary syndromes. 5 High levels of serum LDL are seen in our study also.…”

Section: Discussionmentioning

confidence: 99%

“…Some of the conventional risk factors for atherothrombotic disease aresmoking, hypertension, diabetes, dyslipidemia, and obesity 3 . Some of the emerging risk factors include -microalbuminuria 4 .…”

Section: Introductionmentioning

confidence: 99%

The Role of Coronary Angiography in Assesing the Clinical Severity of Coronary Artery Disease

Dhananjayan

Kumari

2012

Int J of Biomed & Adv Res

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Introduction : We can presume that risk factors are predictive of the degree of anatomical impairment on coronary angiography in coronary artery disease. In the present study, an attempt has been made to address whether the coronary angiography alone is potentially be able in assessing the clinical severity of patients with ACS or can we include the risk factors also in this issue. Methods: 100 Patients with established CAD were divided into 4 groups based on the angiography &clinical severity. Body mass index (B.M.I.), Waist circumference& Waist -hip ratio was calculated. Data collected was then analyzed in relation to the angiographic severity and the clinical presentation using Pearson's chi square test and Analysis of Variance, using SPSS (Statistical Package for the Social Sciences). P value of less than 0.05 was considered as statistically significant. Result: When clinical presentations of coronary artery diseases were compared with angiographic severity clinical presentations did not vary significantly with angiographic severity. But majority of the patients i.e. 80 % had more than 2 risk factors even though the clinical presentations did not vary significantly with the number of risk factors Conclusion: Angiographic severity could not predict the clinical manifestation with much precision. So clinicians should aggressively manage the clinical manifestations of CAD and also should work on the control of possible risk factors.

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Urine Albumin Excretion and Subclinical Cardiovascular Disease

Cited by 142 publications

References 29 publications

Very low-grade albuminuria reflects susceptibility to chronic kidney disease in combination with cardiovascular risk factors

Very low-grade albuminuria reflects susceptibility to chronic kidney disease in combination with cardiovascular risk factors

Hypertension during Pregnancy is Associated with Coronary Artery Calcium Independent of Renal Function

The Role of Coronary Angiography in Assesing the Clinical Severity of Coronary Artery Disease

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