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From the Dipartimento di Cardiologia, Angiologia, e Pneumologia (R.P.,
G.D.'O., M.M.), Medicina Interna (D.G., V. Di B.), e Diabetologia (G.P.,
S.B., M.N., R.N.), Università di Pisa, Pisa, Italy.
Abstract—Increased urine
albumin is associated with atherosclerotic disease and predicts
cardiovascular morbidity and mortality in nondiabetic
populations. This finding is frequently postulated to reflect the
impact of atherosclerotic damage on glomerular and systemic
capillary permeability, an interesting but as yet untested hypothesis.
The transcapillary escape rate of albumin (TERalb,
the 1-hour decline rate of intravenous
125I-albumin, a measure of capillary macromolecular
permeability), albuminuria, lipid levels,
echocardiographic wall thickness, and insulin responses
to oral glucose were measured in 30 untreated dipstick-negative lean
men and clinically stable atherosclerotic peripheral
vascular disease; tolerance to oral glucose was a requirement for
inclusion in the study. Because hypertension per se might influence
TERalb, the sample included either normotensive (n=18,
118±6/72±7 mm Hg) or hypertensive (n=12, 141±7/84±6
mm Hg by 24-hour blood pressure monitoring) arteriopathic patients; 11
normal age- and gender-matched subjects (121±7/76±5 mm Hg) were
used as control subjects. TERalb was higher in patients (10.7±3.2
versus 7.4±1.7%/h, P<0.013), a difference that
persisted after postload glucose, insulin, and lipid levels were
accounted for by covariance analysis;
atherosclerosis and hypertension together did not
further impair vascular permeation to albumin. In contrast with
TERalb, albuminuria was elevated only in the hypertensive
subgroup; the 2 variables showed no relationship, even when the
data were analyzed separately in normotensive and hypertensive
subgroups. Urine albumin correlated positively with 24-hour
blood pressure and wall thickness. Thus, systemic capillary
permeability is altered in nondiabetic atherosclerotic patients
independently from blood pressure levels, but this abnormality is not
reflected by proportionate changes in albuminuria.
© 1998 American Heart Association, Inc.
Scientific Contributions
Transvascular and Urinary Leakage of Albumin in Atherosclerotic and Hypertensive Men
Key Words: capillary permeability • albuminuria • atherosclerosis • hypertension, essential • vascular diseases
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