Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Multicenter Study
. 2010 Jun;3(6):595-604.
doi: 10.1016/j.jcmg.2010.01.008.

Association between coronary artery calcification progression and microalbuminuria: the MESA study

Affiliations
Multicenter Study

Association between coronary artery calcification progression and microalbuminuria: the MESA study

Andrew P DeFilippis et al. JACC Cardiovasc Imaging. 2010 Jun.

Abstract

Objectives: This study sought to evaluate the relationship between microalbuminuria (MA) and the development and progression of atherosclerosis, as assessed by incident and progression of coronary artery calcification (CAC).

Background: MA is associated with an increased risk of cardiovascular disease, but the mechanism by which MA imparts this increased risk is not known.

Methods: The MESA (Multi-Ethnic Study of Atherosclerosis) study is a prospective cohort study of 6,814 self-identified White, African-American, Hispanic, or Chinese participants free of clinical cardiovascular disease at entry. Of the 6,775 individuals with available urine albumin data, we excluded 97 subjects with macroalbuminuria and 1,023 with missing follow-up CAC data. The final study population consists of 5,666 subjects.

Results: At baseline, individuals with MA were more likely to have CAC >0 compared with those without MA (62% vs. 48%, p < 0.0001). During a mean follow-up of 2.4 +/- 0.8 years, those with MA and no CAC at baseline were more likely to develop CAC (relative risk [RR]: 2.05, 95% confidence interval [CI]: 1.41 to 3.02, p < 0.0001) as compared with those without MA in demographic-adjusted analyses. After multivariant adjustment, the relationship was attenuated but remained statistically significant (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005). Among those with CAC at baseline, those with versus those without MA had a 15 (95% CI: 8 to 22, p < 0.0001) volume units higher median increase in CAC in demographic-adjusted analyses. After multivariant adjustment, MA remained associated with incident CAC (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005) and with progression of CAC (median increase in CAC volume score of 9 [95% CI: 2 to 16, p = 0.009]), relative to those without MA.

Conclusions: This large multiethnic, population-based study of asymptomatic individuals demonstrates an increased risk of incident CAC as well as greater CAC progression among those with MA. Further study is needed to determine the degree to which MA precedes and predicts progression of atherosclerosis and how this information can be used to reduce cardiovascular events.

PubMed Disclaimer

Figures

Figure 1
Figure 1. Study Population Subgroups According to Baseline MA and CAC as Well as Follow-Up CAC Progression
This figure illustrates the breakdown of those with versus those without microalbuminuria (MA) at baseline, whether coronary artery calcium (CAC) was identified in these subjects, the percentage of subjects without CAC at baseline who developed CAC on follow-up, and the median increase in CAC among those with CAC at baseline. At baseline, a greater percentage of CAC was identified among those with MA (62%) versus those without MA (48%). A greater likelihood of developing incident CAC at follow-up among those with (28%) versus those without (15%) MA, and a greater median progression of CAC among those with CAC at baseline and MA (+47) versus those without MA (+28) were identified.
Figure 2
Figure 2. Incident CAC per 100 Person-Years According to MA and Stratified by Race/Ethnicity
Overall, those with baseline microalbuminuria (MA) (solid bars) had greater incident coronary artery calcium (CAC) as compared with those without MA (open bars). In this univariant analysis, stratified by self-identified race, the trend of greater incident CAC among those with versus those without MA persisted.
Figure 3
Figure 3. Median CAC Change According to MA and Stratified by Race/Ethnicity Among Those With CAC >0 at Baseline
Overall, those with baseline coronary artery calcium (CAC) and with baseline microalbuminuria (MA) (solid bars) had greater progression of CAC as compared with those without MA (open bars). In this univariant analysis, stratified by self-identified race, the trend of greater CAC progression among those with versus those without MA persisted.

Similar articles

Cited by

References

    1. Gerstein HC, Mann JF, Yi Q, et al. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA. 2001;286:421–426. - PubMed
    1. Ljungman S, Wikstrand J, Hartford M, Berglund G. Urinary albumin excretion—a predictor of risk of cardiovascular disease. A prospective 10-year follow-up of middle-aged nondiabetic normal and hypertensive men. Am J Hypertens. 1996;9:770–778. - PubMed
    1. Wachtell K, Ibsen H, Olsen MH, et al. Albuminuria and cardiovascular risk in hypertensive patients with left ventricular hypertrophy: the LIFE study. Ann Intern Med. 2003;139:901–906. - PubMed
    1. Ibsen H, Olsen MH, Wachtell K, et al. Reduction in albuminuria translates to reduction in cardiovascular events in hypertensive patients: losartan intervention for endpoint reduction in hypertension study. Hypertension. 2005;45:198–202. - PubMed
    1. Clausen P, Jensen JS, Jensen G, Borch-Johnsen K, Feldt-Rasmussen B. Elevated urinary albumin excretion is associated with impaired arterial dilatory capacity in clinically healthy subjects. Circulation. 2001;103:1869–1874. - PubMed

Publication types

MeSH terms