Cardiovascular implications of albuminuria

Abstract

Microalbuminuria is a major independent risk factor for cardiovascular disease (CVD) events in persons with diabetes or hypertension, the general population, and persons with known CVD. Although microalbuminuria is a stronger risk factor in men, women with increased albuminuria levels are also at a higher risk of CVD. Microalbuminuria is an indicator of generalized endothelial injury, a hallmark of systemic atherosclerosis. Treatments that decrease albuminuria, particularly agents that inhibit the renin-angiotensin system, reduce CVD risk in various populations, including those with and without diabetes or hypertension. Whether albuminuria should be a treatment target for CVD is not yet proven. Nevertheless, the measurement of albuminuria is clinically useful to identify high-risk individuals who should receive intensive risk factor management based on current treatment guidelines.

Figure 1

Association of microalbuminuria and cardiovascular morbidity and mortality in type 2 diabetes. Odds ratios of cardiovascular morbidity and mortality in patients with type 2 diabetes with microalbuminuria vs. normoalbuminuria. Reprinted with permission from Arch Intern Med. 1997;157:1413–1418. ² Copyright 1997, American Medical Association. All Rights Reserved.

Figure 2

Survival without ischemic heart disease in hypertensive subjects by albuminuria status. Reprinted with permission from Hypertension. 2000;35:898–903. ³

Figure 3

Risk of cardiovascular death by albuminuria level in the general population. Reprinted with permission from Circulation. 2002;106:1777–1782. ⁴

Figure 4

Urinary albumin and severity of coronary artery disease. ^*p=0.027 vs. Absent and Mild groups Reprinted from Am J Kidney Dis. 1999;34:918–925. Copyright 1999, with permission from the National Kidney Foundation. ⁸

Figure 5

Glomerular structure
Reprinted from Tuttle KR, Stein JH. Diabetic nephropathy. Current Concepts. Kalamazoo, MI: The Upjohn Company; 1989. With permission of Pfizer Inc.