Usefulness of Microalbuminuria Versus the Metabolic Syndrome as a Predictor of Cardiovascular Disease in Women and Men >40 Years of Age (from the Rancho Bernardo Study)

Abstract

To examine the sex-specific contributions of the metabolic syndrome and microalbuminuria to cardiovascular disease (CVD) and coronary heart disease (CHD) mortality in community-dwelling older adults, between 1992-1995, 869 women and 575 men aged 40-96 years (mean 71) completed questionnaires, physical examinations, and fasting laboratory tests. Participants were followed over an average of 8 years. CVD and CHD mortality were analyzed using Cox proportional hazards models. At baseline, 267 participants had the Adult Treatment Panel III metabolic syndrome, 151 had microalbuminuria, and 34 had both. During follow up, there were 180 CVD deaths, including 83 CHD deaths. In women, microalbuminuria was associated with a 2-fold increased risk of CVD and CHD mortality (p ≤ 0.01). Women with both microalbuminuria and the metabolic syndrome (n = 18) had a 3-fold increased risk of CVD mortality and a 5-fold increased risk of CHD mortality compared with women without either (n = 657). A significant interaction existed between microalbuminuria and the metabolic syndrome in the prediction of both CVD and CHD (p = 0.021). In men, neither the combination of the metabolic syndrome and microalbuminuria (n = 16), nor either alone, significantly increased the risk of CVD or CHD mortality. In conclusion, in this cohort, microalbuminuria and the metabolic syndrome together were a more powerful predictor of CVD mortality than either alone in women but not in men. Screening for microalbuminuria in older women may identify women at high risk for CVD mortality, beyond that conferred by risk factors included in the metabolic syndrome.

The association of metabolic clustering and physical activity with cardiovascular mortality: the HUNT study in Norway

“…Even though clustering of CRFs is more prevalent in men than in women,21 the association of CRF with mortality was substantially stronger in women. Although data on CRFs and mortality from CVD in unselected populations are sparse, several studies have reported greater risk among women than in men with diabetes 22 23.…”

Microalbuminuria: Marker or Maker of Cardiovascular Disease

“…The presence of proteinuria independently increased the risk for coronary heart disease (HR 1.72), but the effect on mortality was not determined due to the small number of people who had proteinuria [19]. In the Rancho Bernardo study to examine the gender-specific cardiovascular and cardiac mortality risk of microalbuminuria in community-dwelling older adults (mean age 71 years at baseline) followed up for 8 years, microalbuminuria caused a two-fold increase in risk only in women, but this could be due to survival bias; as women develop cardiovascular disease at an older age than men, they would have been more likely to have survived to be in this cohort [20]. …”

Microalbumin: Urinary Biomarker of Cardiovascular Risk Assessment

“…38 These results were later confirmed by various studies. 22,27,39 Microalbuminuria and coronary artery disease MAU, a marker of endothelial cell dysfunction, is associated with atherosclerosis and is a predictor of coronary artery disease (CAD). It has been suggested that patients with CAD have exaggerated exerciseinduced urinary microalbumin excretion but this is controversial.…”

“…3,4,[7][8][9] MAU is reported to be associated with risk factors of vascular endothelelial injury [10][11][12][13] i.e it is associated with development and progression of coronary heart disease (CHD) [14][15][16][17] and cardiovascular disease (CVD). [18][19][20][21][22] Moreover, MAU is also recognised as predictor of CV and all-cause mortality in general population 14,18,23,24 and type 2 diabetic patients. 25,26 Although it is declared that MAU is a predictor of CV events and of progression to overt nephropathy, it is now recognized that the risk is elevated even in the high normal range of MAU, that is below 30 mg/day.…”