Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Hatlen, Gudrun; Romundstad, Solfrid; Salvesen, Øyvind; Dalen, Håvard; Hallan, Stein

doi:10.1159/000445856

Cited by 2 publications

(1 citation statement)

References 37 publications

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“…Due to the stability of the HUNT study population and the access to free health care to everyone in Norway, our study had a virtually complete follow-up with a median time of 15 years. Measuring of albuminuria relied on the 3 samples of morning urine supplied by our participants, reduces misclassification by artificially increased albumin excretion [41]. Furthermore, our study used validated stroke diagnoses where we were able to distinguish between different subtypes of stroke.…”

Section: Strengths and Limitationsmentioning

confidence: 99%

Low grade albuminuria as a risk factor for subtypes of stroke - the HUNT Study in Norway

et al. 2020

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Background and purpose Albuminuria is a marker for endothelial dysfunction and knowledge on its association with stroke and stroke subtypes are limited. Methods Corresponding data from 7261 participants of the population-based HUNT2 study (1995–1997) was linked with hospital records, identified all patients registered and diagnosed with a first-time stroke. Each diagnosis was validated by reviewal of the medical record appertaining to the individual. We then applied Cox proportional hazard models to estimate the hazard ratios (HRs) for the association between albuminuria (measured as albumin-to-creatinine-ratio, ACR) and diagnosis of stroke and stroke subtypes. Results 703 (9.7%) participants developed a first ischemic stroke during a median follow-up of 15 years. Higher albuminuria was associated with a higher rate for ischemic stroke and the risk rose steadily with increasing ACR (15% increment per unit increase in ACR concentration in mg/mmol). In the fully adjusted model, the HR for all ischemic strokes was 1.56 (95% CI 1.24–1.95) for those with an ACR ≥3 mg/mmol compared to participants with an ACR < 1 mg/mmol. Overall, increasing ACR was associated with a higher risk of all ischemic stroke subtypes. This was seen to be strongest for lacunar stroke (HR 1.75, CI 1.12–2.72, p = 0.019), and also for stroke of undetermined etiology (HR 1.53, CI 1.11–2.11, p = 0.009) and those caused by atherosclerosis in the large arteries (HR 1.51, CI 0.78–2.94, p = 0.186) than for cardio-embolic stroke (HR 1.22, CI 0.64–2.3, p = 0.518). Conclusions Albuminuria is an important risk factor, potentially already at low grade, for ischemic stroke especially for lacunar subtype. Measuring albuminuria is both cheap and readily available. This offers the opportunity to evaluate the risk for endothelial dysfunction and thus the subsequent risk for stroke and cerebral small vessel disease.

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Section: Strengths and Limitationsmentioning

confidence: 99%

Low grade albuminuria as a risk factor for subtypes of stroke - the HUNT Study in Norway

et al. 2020

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Prognostic impact of baseline urinary albumin excretion rate in patients with resistant hypertension: a prospective cohort study

et al. 2017

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Moderately increased albuminuria, defined as urinary albumin excretion rate (UAER) between 30 and 300-mg/24-h is a well-known cardiovascular risk factor, especially in diabetic and hypertensive patients. This study aim to analyze the prognostic value of baseline UAER in a still understudied group, patients with resistant hypertension (RHT). This is a prospective observational study, which had enrolled 1048 outpatients with RHT, who were submitted to a clinical-laboratory assessment and ambulatory blood pressure monitoring (ABPM) during the follow-up. Primary endpoints were a composite of fatal and non-fatal cardiovascular events, all-cause mortality and cardiovascular mortality. Survival analysis by multiple Cox regression assessed the associations among endpoints, baseline UAER, glomerular filtration rate (GFR), and ABPM control. After a mean 7.5 years follow-up, 233 patients died, 120 from cardiac death; 215 cardiovascular events occurred, 90 strokes and 116 coronary diseases. UAER above 30-mg/24-h increased above 40% the risk of fatal and non-fatal cardiovascular events, and of all-cause mortality. At these UAER levels, secondary outcomes were associated to increased risk of stroke and risk of end-stage renal disease, but did not affect coronary events. Both the GFR below 60-mL/min and uncontrolled ABPM were related to nearly two-fold raised risk of fatal and non-fatal cardiovascular events, when coupled with UAER above 30-mg/24-h. In conclusion, moderately increased albuminuria predicts cardiovascular events and all-cause mortality in RHT, and its prognostic impact is enhanced in association with a GFR under 60-mL/min and uncontrolled baseline ABPM.

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Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary Events

Cited by 2 publications

References 37 publications

Low grade albuminuria as a risk factor for subtypes of stroke - the HUNT Study in Norway

Low grade albuminuria as a risk factor for subtypes of stroke - the HUNT Study in Norway

Prognostic impact of baseline urinary albumin excretion rate in patients with resistant hypertension: a prospective cohort study

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