Prevalence of Microalbuminuria and Its Association with Subclinical Carotid Atherosclerosis in Middle Aged, Nondiabetic, Low to Moderate Cardiovascular Risk Individuals with or without Hypertension.

Eva Szabóová,Alexandra Lisovszki,Peter Kolarčik,Eliška Fatľová,Peter Szabó,Tomáš Molnár

doi:10.3390/diagnostics11091716

Abstract

Microalbuminuria is closely associated with the risk of cardiovascular disease and all-cause mortality in the general population. Less is known about its relationship with subclinical atherosclerosis. We aimed to assess the prevalence of microalbuminuria and its relationship with subclinical atherosclerosis in middle-aged, nondiabetic, apparently healthy individuals (N = 187; 40.1% men, 59.9% women; aged 35–55 years) as well as to evaluate its potential associations with established risk modifiers, especially with the presence of carotid plaque. Clinical and laboratory parameters, the estimated 10-year fatal cardiovascular risk (SCORE), as well as circulating, functional (flow mediated vasodilation, ankle-brachial index, augmentation index, and pulse wave velocity), and morphological markers (mean carotid intima–media thickness, and carotid plaque) of subclinical atherosclerosis were analysed in group with vs. without microalbuminuria. Microalbuminuria was present in 3.8% of individuals with SCORE risk 0.43 ± 0.79%. Functional markers predominated in both groups. Carotid intima–media thickness (mean ± SD) in both groups was in range: 0.5–0.55 ± 0.09–0.14 mm. Carotid plaque was more frequent in group with (14.3%) vs. without (4.4%) microalbuminuria. Microalbuminuria had no statistically significant effect on most markers of subclinical atherosclerosis, but the increasing value of microalbuminuria was significantly associated with the occurrence of carotid plaque (p = 0.035; OR = 1.035; 95% CI = 1.002–1.07). Additional multiple logistic regression analysis, where variables belonged to microalbuminuria, number of risk factors, and family history, finally showed only two variables: microalbuminuria (p = 0.034; OR = 1.04; 95%CI = 1.003–1.09) and the number of risk factors (p = 0.006; OR = 2.15; 95% CI = 1.24–3.73) with independent and significant impact on the occurrence of carotid plaque. Our results may indicate an association of microalbuminuria with the presence of carotid atherosclerotic plaque; in addition, microalbuminuria and the number of risk factors appear to be possible predictors of the carotid plaque occurrence. Monitoring microalbuminuria may improve the personalized cardiovascular risk assessment in nondiabetic, low-to-moderate cardiovascular risk individuals with or without hypertension.

Highlights

Microalbuminuria is closely associated with renal and cardiovascular (CV) morbidity and mortality in diabetic [1], hypertensive [2], and elderly patients [3], but predicts all-cause mortality in the general population [4]
The comparison of the microalbuminuria subgroups showed no differences in average values and pathological categories of monitored parameters between individuals with microalbuminuria and those with normoalbuminuria
In the step we focused on the prediction capacity of microalbuminuria together in a common model with all the statistically significant variables on the occurrence of carotid plaque and the only significant determinant of microalbuminuria

Summary

Introduction

Microalbuminuria is closely associated with renal and cardiovascular (CV) morbidity and mortality in diabetic [1], hypertensive [2], and elderly patients [3], but predicts all-cause mortality in the general population [4]. Albuminuria is used as an indicator of generalized endothelial dysfunction, an early stage of atherosclerosis [5]. Some widely available hematological and coagulation parameters can help in risk stratification of patients with acute coronary syndromes, some red blood cell and platelet parameters may indicate proatherogenic lipoprotein profiles in the general population [6,7,8]. Arterial stiffness is associated with traditional risk factors for atherosclerosis [12] and is an independent predictor of CV events [13] mainly in selected high-risk patients with arterial hypertension (AH), diabetes mellitus (DM), and end-stage chronic renal failure [12]

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