European Heart Journal Advance Access originally published online on April 21, 2005
European Heart Journal 2005 26(12):1242-1243; doi:10.1093/eurheartj/ehi274
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Measurement of albuminuria during acute myocardial infarction and its relation with prognosis: reply
Department of Cardiology and Endocrinology
Frederiksberg University Hospital
DK-2000 Frederiksberg
Denmark
E-mail address: kragelund{at}dadlnet.dk
Department of Endocrinology
Hillerød University Hospital
DK-3400 Hillerød
Denmark
Department of Cardiology
Rigshospitalet,
DK-2100 Copenhagen
Denmark
Department of Cardiology
Bispebjerg University Hospital
DK-2400 Copenhagen
Denmark
We thank Berton et al. for the interest in our work.1 They argue that the predictive power of albumin excretion has been overlooked due to a series of methodological problems in our study. We agree with Berton et al.2 that measuring urinary albumin excretion rate in 24 h urine samples would more closely reflect the ‘real’ albumin excretion rate, and it is well established that albumin excretion rate decline during the first few days following acute myocardial infarction.2 We have adequately described the methodology used, and the same weaknesses that exist for albumin excretion exist for the other markers as well. In a perfect world all samples would have been taken at the same time. Our study is a clinical study of patients admitted to hospital with acute myocardial infarction, and in this setting it is not possible always to collect samples completely homogenously. Despite this, insulin was a reliable marker of increased risk. If measurement of albumin excretion warrants more standardized and complicated methods than the ones we used, it might not have any clinical importance. The conclusion that insulin is a marker of long-term mortality independently of various other cardiovascular risk markers including urinary albumin excretion has been consistent for a long period of time of >5 years. An obvious explanation to the discrepancies between our study and that of Berton et al.2 is the length of follow-up. All markers of risk tend to loose importance with time. Had we stopped follow-up after just 1 year as did Berton et al.,2 our results would have been much more significant. It will be interesting to learn whether urinary albumin excretion rate in the population of Berton et al.2 will still have prognostic importance after 5 years. We acknowledge the comment on the diabetic subpopulation; however, it is difficult to refer to a paper that at that time was not yet published.
References
- Kragelund C, Snorgaard O, Kober L, Bengtsson B, Ottesen M, Hojberg S, Olesen C, Kjaergaard JJ, Carlsen J, Torp-Petersen C; TRACE Study Group. Hyperinsulinaemia is associated with increased long-term mortality following acute myocardial infarction in non-diabetic patients. Eur Heart J 2004;25:1891–1897.
[Abstract/Free Full Text] - Berton G, Cordiano R, Palmieri R, Cucchini F, De Toni R, Palatini P. Microalbuminuria during acute myocardial infarction; a strong predictor for 1-year mortality. Eur Heart J 2001;22:1466–1475.
[Abstract/Free Full Text]
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