Albuminuria and Risk of Cardiovascular Events, Death, and Heart Failure in Diabetic and Nondiabetic Individuals

Gerstein, Hertzel C.; Mann, Johannes F.E.; Yi, Qilong; Zinman, Bernard; Dinneen, Seán F.; Hoogwerf, Byron J.; Halle, J; Young, James F.; Rashkow, Andrew; Joyce, Carol; Nawaz, Shah; Yusuf, Salim

doi:10.1001/jama.286.4.421

Cited by 2,161 publications

(1,545 citation statements)

References 43 publications

Supporting

Mentioning

1,402

Contrasting

Unclassified

Order By: Relevance

“…Albuminuria is well recognized as a good biomarker for endothelial dysfunction and atherosclerotic vascular disease, including stroke 28, 29. As we therefore expected, the present study showed that higher UACR level was significantly associated with a higher risk for the development of VaD, especially VaD with prior stroke events.…”

Section: Discussionsupporting

confidence: 78%

Albuminuria Increases the Risks for Both Alzheimer Disease and Vascular Dementia in Community‐Dwelling Japanese Elderly: The Hisayama Study

Takae

Hata

Ohara

et al. 2018

JAHA

View full text Add to dashboard Cite

BackgroundEpidemiologic evidence has emerged to reveal an association of albuminuria and low estimated glomerular filtration rate (eGFR) with dementia, but the findings are inconsistent. In addition, there are limited studies addressing the association between albuminuria and Alzheimer disease (AD).Methods and ResultsA total of 1562 community‐dwelling Japanese subjects aged ≥60 years without dementia were followed up for 10 years. The outcomes were incidence of all‐cause dementia and its subtypes, namely, AD and vascular dementia (VaD). The hazard ratios for the outcomes were estimated according to urine albumin–creatinine ratio (UACR) and eGFR levels using a Cox proportional hazards model. During the follow‐up, 358 subjects developed all‐cause dementia (238 AD and 93 VaD). Higher UACR level was significantly associated with greater multivariable‐adjusted risks of all‐cause dementia (hazard ratios [95% confidence intervals]: 1.00 [reference], 1.12 [0.78–1.60], 1.65 [1.18–2.30], and 1.56 [1.11–2.19] for UACR of ≤6.9, 7.0–12.7, 12.8–29.9, and ≥30.0 mg/g, respectively), AD (1.00 [reference], 1.20 [0.77–1.86], 1.75 [1.16–2.64], and 1.58 [1.03–2.41], respectively), and VaD (1.00 [reference], 1.03 [0.46–2.29], 1.94 [0.96–3.95], and 2.19 [1.09–4.38], respectively). On the other hand, lower eGFR level was marginally associated with greater risk of VaD, but not AD. Subjects with UACR ≥12.8 mg/g and eGFR of <60 mL/min per 1.73 m2 had 3.3‐fold greater risk of VaD than those with UACR <12.8 mg/g and eGFR of ≥60 mL/min per 1.73 m2.ConclusionsAlbuminuria is a significant risk factor for the development of both AD and VaD in community‐dwelling Japanese elderly. Moreover, albuminuria and low eGFR are mutually associated with a greater risk of VaD.

show abstract

Section: Discussionsupporting

confidence: 78%

Albuminuria Increases the Risks for Both Alzheimer Disease and Vascular Dementia in Community‐Dwelling Japanese Elderly: The Hisayama Study

Takae

Hata

Ohara

et al. 2018

JAHA

View full text Add to dashboard Cite

show abstract

“…No doubt other risk scores, such as the risk score in the ARIC study [16], will be developed to include parameters that have more recently been shown to be predictive of cardiovascular mortality, such as C-reactive protein, fibrinogen and other markers of inflammation, microalbuminuria and numerous other factors [39,40,41].…”

Section: Discussionmentioning

confidence: 99%

Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE Study

Balkau

Hu²,

Qiao³

et al. 2004

Diabetologia

138

View full text Add to dashboard Cite

Aims/hypothesis. Risk scores have been developed to predict cardiovascular or coronary risk, and while most have included diabetes as a risk factor, none have included lower glucose concentrations, either at fasting or following a 2-h oral glucose tolerance test. This article develops 5-and 10-year risk scores for cardiovascular mortality that include glucose concentrations as well as known diabetes status. Methods. Data is from the DECODE cohort: 16,506 men and 8,907 women from 14 European studies. The risk factors studied were as follows: age, fasting and 2-h glucose (including cases of known diabetes), fasting glucose alone (including cases of known diabetes), cholesterol, smoking status, systolic blood pressure and BMI. For an absolute risk score the 1995 countryand sex-specific cardiovascular death rates were used. Results. In men, for both 5-and 10-year cardiovascular mortality, after adjusting for age and study centre, all studied risk factors, except BMI, were significantly associated with cardiovascular mortality (p<0.05). These results were unchanged in multivariate models with all factors included. In women, after adjusting for age and centre, glucose categories, systolic blood pressure and BMI were predictive of 5-year cardiovascular mortality. With all factors in the model, only age and glucose categories were predictive. In terms of 10-year cardiovascular mortality, smoking status and blood pressures were also predictive in the women. For men and women, the same scores were used for the risk factors, except for age and glucose categories where the hazard ratios differed significantly. Conclusions/interpretation. Including glucose concentrations as well as diabetic status provides quantitative information on cardiovascular risk prediction.

show abstract

“…Patients with marked microalbuminuria may have occult small vessel disease and should be assessed thoroughly. 30 Finally, morbidly obese patients with 1 or more other serious comorbidities such as uncontrolled hypertension, micro-and macrovascu-lar complications, diffuse CAD, previous myocardial infarction or strokes (including transient ischemic attacks), or significant microalbuminuria should not be offered liver transplantation. This process will allow us to offer liver transplantation in a "selective" manner to some morbidly obese patients, thereby assuring a low morbidity and a better long-term survival.…”

Section: See Article On Page 1678mentioning

confidence: 99%

Morbid obesity with one or more other serious comorbidities should be a contraindication for liver transplantation

Thuluvath

2007

Liver Transpl

View full text Add to dashboard Cite

The prevalence of obesity is increasing in the United States and the rest of the world. The World Health Organization reported last year that over a billion people in the world are obese, surpassing 600 million malnourished people. In some ways, this is a reassuring sign that we are combating poverty in the world, but the impact of obesity on long-term morbidity, mortality, and utilization of health resources is similar or higher. [1][2][3][4][5] The reports from the Centers for Disease Control and the National Health and Nutrition Examination Surveys suggest that Ͼ20% of the U.S. population is obese as defined by a body mass index (BMI) Ͼ30 kg/ m 2 . Whereas infections are the most common causes of death in the malnourished, degenerative and vascular diseases are the common causes of death in obese people. [1][2][3][4][5] The Centers for Disease Control estimates that approximately 100 billion dollars are spent every year in the United States on obesity-related type 2 diabetes mellitus and 22 billion on obesity-related osteoarthritis.The United Network for Organ Sharing database from 1988 to 1996 showed that 16.8% of liver transplant recipients had BMI Ն30 kg/m 2 and of these 5.3% were severely obese (BMI Ն35 kg/m 2 ) and 2.1% were morbidly obese (BMI Ն40 kg/m 2 ). 6 The study reported in this issue of Liver Transplantation by Pelletier et al. 7 shows that the prevalence of obesity has increased significantly in more recent years. Of those who underwent transplantation between 2001 and 2004, 32.5% were obese, and among them, 8.4% were severely obese and 3.2% were morbidly obese. Within a decade, it appears that the prevalence of obesity (BMI Ն30 kg/m 2 ) has increased by 93% among liver transplant recipients, and moreover, there was 58% increase in severe obesity and 52% increase in morbid obesity. This increase is mostly a reflection of the changes in the general population. Fluid overload and inactivity, probably related to the advanced liver disease, may have contributed to the increased prevalence of obesity in this population, but it is difficult to assume that these factors have changed in the past decade. 4 Nevertheless, these data indicate that we need to continue to monitor the outcomes of obese patients on a continuous basis as the epidemiology is rapidly shifting in the wrong direction.The impact of obesity on renal transplantation has been studied more extensively than liver transplantation. 8,9 An analysis of 51,927 renal transplant recipients showed that extremes of BMI (Ͻ18 and Ͼ36) were associated with worse graft and patient survival. 8 In addition, higher BMI was associated with delayed graft function and chronic graft failure. Registry data (from 1987 to 2002) on 6,658 children aged 2 to 17 yr who received renal transplantation showed that BMI Ͼ95 percentile (9.7% of the study population) for age was associated with a higher risk of death (relative risk 2.9 for cadaver and 3.7 for living donor) and graft loss (19% vs. 10% for nonobese) due to thrombosis. 10 Obesity has also been described a...

show abstract

Albuminuria and Risk of Cardiovascular Events, Death, and Heart Failure in Diabetic and Nondiabetic Individuals

Abstract: Our results indicate that any degree of albuminuria is a risk factor for CV events in individuals with or without DM; the risk increases with the ACR, starting well below the microalbuminuria cutoff. Screening for albuminuria identifies people at high risk for CV events.

Cited by 2,161 publications

References 43 publications

Albuminuria Increases the Risks for Both Alzheimer Disease and Vascular Dementia in Community‐Dwelling Japanese Elderly: The Hisayama Study

Albuminuria Increases the Risks for Both Alzheimer Disease and Vascular Dementia in Community‐Dwelling Japanese Elderly: The Hisayama Study

Prediction of the risk of cardiovascular mortality using a score that includes glucose as a risk factor. The DECODE Study

Morbid obesity with one or more other serious comorbidities should be a contraindication for liver transplantation

Contact Info

Product

Resources

About