Published online before print June 13, 2005, doi: 10.1161/01.HYP.0000171189.48911.18
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(Hypertension. 2005;46:38.)
© 2005 American Heart Association, Inc.
Original Articles |
Urine Albumin Excretion and Subclinical Cardiovascular Disease
From the Departments of Preventive Medicine and Medicine (H.K.), Division of Nephrology, Loyola University, Maywood, Ill; Division of Epidemiology (D.R.J.), University of Minnesota, Minneapolis, Minn and Department of Nutrition, University of Oslo, Norway; Division of Epidemiology and Clinical Applications (D.B.), National Heart, Lung, and Blood Institute, Bethesda, Md; Department of Medicine (W.P.), Johns Hopkins University School of Medicine, Baltimore, Md; Department of Medicine (M.F.S.), School of Medicine, University of California, Los Angeles, Los Angeles, Calif; Division of Cardiology (R.D.), Los Angeles Biomedical Research Institute at Harbor-UCLA Medical Center, Torrance, Calif; Laboratory for Clinical Biochemistry Research (R.T.), Departments of Pathology and Biochemistry, College of Medicine, University of Vermont, Burlington, Vt; Department of Preventive Medicine (R.C.), Loyola University, Maywood, Ill; Department of Preventive Medicine (K.L.), Feinberg School of Medicine, Northwestern University, Chicago, Ill.
Correspondence to Holly Kramer, MD, MPH, Loyola Medical Center, Department of Preventive Medicine, 2160 First Avenue, Maywood, IL 60153. E-mail hkramer{at}lumc.edu
We examined the association between urine albumin excretion (UAE) and common and internal carotid artery intima-media thickness (IMT), end-diastolic left ventricular (LV) mass, and coronary artery calcification (CAC) scores using data from the Multi-Ethnic Study of Atherosclerosis (MESA), a population-based study of 6814 adults aged 45 to 85 years without clinical cardiovascular disease (CVD). The mean age of the MESA participants was 62.7 years, 47% were male, and 15% had diabetes mellitus (DM). Sex-specific spot urine albumin/creatinine ratios were used to define 4 UAE categories: normal, high normal, microalbuminuria, and macroalbuminuria. CAC scores were log-transformed after adding 1 to all scores. Mean values of subclinical CVD measures were computed by level of UAE after adjustment for blood pressure, DM, and other covariates. After adjustment for all covariates, geometric mean CAC scores were higher among participants with high normal UAE (8.8; P=0.07), microalbuminuria (9.9; P=0.002), and macroalbuminuria (13.1; P=0.02) compared with normal UAE (7.4), but only microalbuminuria reached statistical significance. Mean LV mass (g/m2.7) was significantly higher in participants with high normal UAE (37.0; P=0.001), microalbuminuria (38.3; P
0.0001), and macroalbuminuria (42.3; P0.0001) compared with normal UAE (36.0) after adjustment for all covariates. No significant difference in mean carotid IMT was found after adjustment for all covariates. Similar results were noted in MESA participants with and without DM. In conclusion, higher UAE, including levels below microalbuminuria, may reflect the presence of subclinical CVD among adults without established CVD.
Key Words: cardiovascular diseases • urine
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