European Heart Journal Advance Access originally published online on November 30, 2004
European Heart Journal 2005 26(3):279-287; doi:10.1093/eurheartj/ehi014
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European Heart Journal vol. 26 no. 3 © The European Society of Cardiology 2004; all rights reserved.
Urinary albumin excretion is independently associated with carotid and femoral artery atherosclerosis in the general population
1Department of Neurology, Innsbruck Medical University Clinic, Anichstrasse 35, A-6020 Innsbruck, Austria
2Department of Internal Medicine, Bruneck Hospital, Italy
Received 7 May 2004; revised 27 July 2004; accepted 26 August 2004; online publish-ahead-of-print 30 November 2004.
* Corresponding author. Tel: +43 512 504 24244; fax: +43 512 504 24260. E-mail address: johann.willeit{at}uibk.ac.at
Aims In diabetic patients, increased urinary albumin excretion (UAE), termed microalbuminuria when in the range between 30 and 300 mg/dL per day, is associated with a higher risk of atherosclerosis and its complications. Whether or not this notion applies to the general population is a matter of ongoing controversy because none of the few previous investigations among non-diabetics strictly represent the general community.
Methods and results Urinary albumin-to-creatinine ratio (uACR), a measure of UAE, was assessed from overnight spot urine samples in a population-based cohort of 684 individuals. The ratio was significantly related to age, gender, blood pressure, diabetes, markers of systemic inflammation, liver enzymes, and parathyroid hormone levels (P<0.001 each). Moreover, uACR emerged as a highly significant risk predictor of carotid and femoral artery atherosclerosis in the general community and the non-diabetic subpopulation alike (age/sex-adjusted P<0.001 each). In multivariable logistic regression analyses, odds ratios (95% CI) of carotid and femoral atherosclerosis amounted to 1.28 (1.01–1.61) and 1.44 (1.15–1.81) for a one unit increase in loge-transformed uACR (P=0.040 and 0.002). Corresponding odds ratios in non-diabetic subjects were 1.41 (1.09–1.84) and 1.54 (1.19–1.99) (P=0.010 and 0.001). Multivariable linear regression analyses yielded significant, or near significant, relations with carotid and femoral artery intima–media thickness and atherosclerosis scores (P=0.058–0.001).
Conclusion The uACR is significantly and independently associated with the presence and severity of atherosclerosis in the general population. The relation obtained was of a dose–response type and extended to levels far below what is termed microalbuminuria. The novel aspects of our study are its focus on various vascular territories and representivity of the general healthy population.
Key Words: Urinary albumin excretion • Atherosclerosis • Peripheral vascular disease • Risk factors • Epidemiology
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