Microalbuminuria is a marker of left ventricular hypertrophy but not hyperinsulinemia in nondiabetic atherosclerotic patients.

Abstract

Microalbuminuria predicts cardiovascular events in diabetic and nondiabetic patients. For a better understanding of the physiopathological importance of microalbuminuria in atherosclerotic disease, we evaluated the relation between urinary albumin excretion and arterial blood pressure, left ventricular mass, insulin, and lipid levels. The studies were conducted in patients with atherosclerotic peripheral vascular disease. Urinary albumin excretion (studied by nephelometry; an average of triplicate collections from 8 PM to 8 AM), casual blood pressure, echocardiographic left ventricular mass index and wall thickness, plasma immunoreactive insulin and C-peptide (both basally and after a 75-g oral glucose load), blood lipids, and fibrinogen were studied in eight normal subjects and 20 nonobese, nondiabetic male patients with angiographically documented atherosclerotic peripheral vascular disease and preserved renal function, 12 of whom were either hypertensive or on antihypertensive treatment Eight patients were microalbuminuric (urinary albumin >20 ^ig/min) and 12 were not Ankle-arm index and calf and foot transcutaneous oxygen tension were reduced in comparison with normal control subjects but superimposable between the two patient groups to indicate a comparable clinical progression of the vascular disease. In the microalbuminuric subjects, left ventricular mass index was greater, interventricular septum was thicker, and cardiac hypertrophy was more frequent than in nonmicroalbuminuric patients. The prevalence of hypertension tended to be greater and systolic blood pressure values were higher in the presence of microalbuminuria. Overall, a highly significant relation existed between urinary albumin excretion and left ventricular mass. Systolic blood pressure was greater and a history of arterial hypertension was more frequent among microalbuminurics, whereas diastolic blood pressure values showed a statistically significant correlation with both variables. No difference in postload blood glucose and basal and stimulated insulin and C-peptide existed between the two groups of patients. Plasma lipids and fibrinogen did not differ significantly. Urinary albumin excretion was mainly a covariate of left ventricular mass values in these nondiabetic patients with macrovascular disease, but the data do not support previous suggestions of microalbuminuria as a marker of either widespread atherosclerosis as such or insulin resistance. The association between microalbuminuria and cardiac hypertrophy can be explained by coexistent arterial hypertension, an abnormality widely prevalent in atherosclerotic patients, although the limits of conventional blood pressure measurements as an index of daily pressor load tend to mask it The underlying presence of a major risk factor such as cardiac hypertrophy might explain the previously reported predictive power of microalbuminuria for cardiac events. (

Microalbuminuria, an integrated marker of cardiovascular risk in essential hypertension

“…Since the very first descriptions, [115][116][117][118] the association between increased UAE and left ventricular hypertrophy, either by ECG or echographically, has been almost universally confirmed, 3,12,14,49,50,76,[119][120][121][122][123] with a notable exception in patients with stage I hypertension and a high prevalence of white coat hypertension. 24 This discrepant behaviour adds value to the combined determination of the two markers of renal and cardiac involvement to stage risk during the initial phase of hypertension.…”

Silent ischemia is more prevalent among hypertensive patients with microalbuminuria and salt sensitivity

“…7 A wide variability of UAE has also been shown among normotensive healthy subjects. [8][9][10] The increasing interest in the significance of microalbuminuria derives, in large part, from the recognition that a rise in UAE is associated with an increased incidence of cardiovascular complications 11 and morbid events, such as left ventricular hypertrophy, [12][13][14] myocardial ischemia, 15,16 hypertensive retinopathy, and increased thickness of the carotid artery. 17 The predictive value of microalbuminuria persists even when data are corrected for age, sex, obesity and levels of blood pressure.…”

Urinary albumin excretion and heart rate variability in obese women

“…1±7 Furthermore, slightly elevated UAE (microalbuminuria) has been reported to be associated with premature mortality in the general population. 8,9 Statistical relationships have been found between UAE and established risk factors for cardiovascular disease (CVD) such as blood pressure, 10±12 dyslipidaemia, 11±13 impaired glucose tolerance, 14 insulin resistance, 15,16 left ventricular hypertrophy 17 and blood coagulation abnormalities as well as disordered endothelial function. 16,18,19 UAE has also been shown to be associated with an increased intima-media thickness of the common carotid artery in hypertensive men with diabetes mellitus.…”