Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease

Garg, Jay; Bakris, George L.

doi:10.1191/1358863x02vm412ra

Cited by 255 publications

(195 citation statements)

References 78 publications

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“…Among factors such as more extensive coronary atherosclerosis in diabetic subjects, alterations in the fibrinolytic system that facilitate reocclusion after fibrinolysis [21,22], diabetic cardiomyopathy with systolic or diastolic dysfunction [23], and autonomic imbalance [24], particular emphasis has been placed on endothelial dysfunction leading to impaired myocardial perfusion [25]. Albuminuria is considered to be a marker of widespread endothelial dysfunction enhancing atherogenesis, and several studies have shown that the mortality risk is 2.3 to 4 times higher in diabetic patients with microalbuminuria than in those without [26,27,28]. Thus, it is possible that the glomerular albumin leak reflects a widespread atherosclerosis-mediated capillary vasculopathy [25,26,27,29].…”

Section: Discussionmentioning

confidence: 99%

“…Albuminuria is considered to be a marker of widespread endothelial dysfunction enhancing atherogenesis, and several studies have shown that the mortality risk is 2.3 to 4 times higher in diabetic patients with microalbuminuria than in those without [26,27,28]. Thus, it is possible that the glomerular albumin leak reflects a widespread atherosclerosis-mediated capillary vasculopathy [25,26,27,29]. Although we have no ACR values for the patients prior to AMI, it is reasonable to assume that the large difference in ACR between the diabetic AMI group and the diabetic control group is accounted for by AMI.…”

Section: Discussionmentioning

confidence: 99%

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Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Berton¹,

Cordiano²,

Palmieri³

et al. 2004

Diabetologia

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Aims/hypothesis. Diabetes mellitus is associated with increased mortality in subjects with acute myocardial infarction (AMI). We aimed to estimate the risk of mortality in AMI patients with and without diabetes using the urinary albumin : creatinine ratio (ACR).Methods. This is a prospective study of 121 consecutive, non-selected diabetic AMI patients, 121 age-and sex-matched non-diabetic AMI patients and 61 diabetic non-AMI outpatients as control subjects. All data were obtained during the first 7 days of hospitalisation and each AMI patient was followed for a period of exactly 3 years. Baseline ACR RIA measurements were made on the 1st, 3rd and 7th days of admission. Results. Adjusted ACR values were significantly higher in the diabetic AMI patients than in the diabetic control outpatients (p<0.0001), and a significant difference was observed between the weekly ACR slopes for these two groups (p<0.0001). Microalbuminuria was more prevalent in the diabetic AMI patients than in the non-diabetic AMI patients on the 1st day (62% vs 46%, p=0.01) and 3rd day (41% vs 29%, p=0.04). Among the AMI patients with normoalbuminuria (ACR <30 µg/mg), the mortality rate was 11.6% for the patients without diabetes and 33.8% for those with diabetes (p=0.001). The mortality rate was much higher among the AMI patients with microalbuminuria (ACR ≥30 µg/mg) and similar for the diabetic (68.0%) and non-diabetic patients (74.3%). In a multivariable Cox model, ACR (p<0.0001) and diabetes status (p=0.01) were associated with adverse outcome even when several other clinical variables were included in the model. Furthermore, a negative interaction was found between diabetes and ACR (p=0.01). Conclusions/interpretation. Microalbuminuria frequently occurs in diabetic and non-diabetic AMI patients during the first 3 days of admission to hospital and can be used to identify subjects at high risk of mortality.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Berton¹,

Cordiano²,

Palmieri³

et al. 2004

Diabetologia

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“…macroalbuminuria) defined as 4300 mg/day of protein in the urine or a urinary albumin excretion rate (UAER) of 4200 mg/ min is a hallmark of established kidney disease, microalbuminuria (30-300 mg/day of protein in the urine or an UAER of 20-200 mg/min) is associated with increased cardiovascular risk and, in many cases if not reduced will progress to overt kidney disease. 18,19 Indeed, the association between albuminuria and cardiovascular risk is a continuous one and even lower levels of albuminuria are associated with an elevated risk. 20 Aggressive blood pressure control is an important component of albuminuria reduction in microalbuminuric patients, but RAAS blockade once again reduces microalbuminuria to a greater degree than can be accounted for by effects on blood pressure reductions.…”

Section: Introductionmentioning

confidence: 99%

Rationale and design of a study to evaluate management of proteinuria in patients at high risk for vascular events: the IMPROVE trial

et al. 2006

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Declining kidney function predicts increasing cardiovascular risk in people with hypertension. Microalbuminuria is a marker for cardiovascular risk and declining kidney function. Agents that block the renin-angiotensin-aldosterone system (RAAS), notably angiotensin-converting enzyme (ACE) inhibitors and angiotensin receptor blockers (ARBs), reduce proteinuria and microalbuminuria, lower blood pressure and slow the progression of proteinuric kidney disease. Evidence is accumulating that the combination of an ACE inhibitor and an ARB is the optimal means of RAAS blockade in this setting, slowing the progression of nephropathy independently of blood pressure lowering to a greater degree than can be achieved using maximum approved doses of either agent alone. However, the emerging therapeutic potential of ACE inhibitor/ARB combination therapy in hypertensive kidney disease requires further characterization. The Irbesartan in the Management of PROteinuric patients at high risk for Vascular Events trial aims to determine definitively whether the combination therapy of an ARB, irbesartan and an ACE inhibitor, ramipril, is more effective than ramipril alone in reducing the urinary albumin excretion rate in patients at high cardiovascular risk with hypertension and proteinuria or microalbuminuria.

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“…1,2 Microalbuminuria is associated with abnormal vascular responsiveness and increased membrane permeability in people with hypertension or diabetes. 2,3 Many of the causes of microalbuminuria relate to increased inflammation of the vasculature and subsequent increased vascular permeability in conditions such as fever and diabetes.…”

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confidence: 99%

Differential Effects of β-Blockers on Albuminuria in Patients With Type 2 Diabetes

et al. 2005

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Abstract-Increases in the cardiovascular risk marker microalbuminuria are attenuated by blood pressure reduction using blockers of the renin-angiotensin system. Such changes in microalbuminuria have not been observed when ␤-blockers are used. A prespecified secondary end point of the Glycemic Effects in Diabetes Mellitus Carvedilol-Metoprolol Comparison in Hypertensives (GEMINI) trial was to examine the effects of different ␤-blockers on changes in albuminuria in the presence of renin-angiotensin system blockade. Participants with hypertension and type 2 diabetes were randomized to either metoprolol tartrate (nϭ737) or carvedilol (nϭ498) in blinded fashion after a washout period of all antihypertensive agents except for angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Blinded medication was titrated to achieve target blood pressure, with a-5 month follow-up period. The current analysis examined microalbuminuria, using spot urine albumin:creatinine, in participants who had values at screening and trial end. A greater reduction in microalbuminuria was observed for those randomized to carvedilol (Ϫ16.2%⌬; 95% confidence interval, Ϫ25.3, Ϫ5.9; Pϭ0.003). Of those with normoalbuminuria at baseline, fewer progressed to microalbuminuria on carvedilol versus metoprolol (20 of 302 [6.6%] versus 48 of 431 [11.1%], respectively; Pϭ0.03). Microalbuminuria development was not related to differences in blood pressure or achievement of blood pressure goal (68% carvedilol versus 67%, metoprolol). Presence of metabolic syndrome at baseline was the only independent predictor of worsening albuminuria throughout the study (Pϭ0.004). ␤-Blockers have differential effects on microalbuminuria in the presence of renin-angiotensin system blockade. These differences cannot be explained by effects on blood pressure or ␣1-antagonism but may relate to antioxidant properties of carvedilol.

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Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease

Cited by 255 publications

References 78 publications

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Albumin excretion in diabetic patients in the setting of acute myocardial infarction: association with 3-year mortality

Rationale and design of a study to evaluate management of proteinuria in patients at high risk for vascular events: the IMPROVE trial

Differential Effects of β-Blockers on Albuminuria in Patients With Type 2 Diabetes

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