DOI QR코드

DOI QR Code

Urine Albumin Creatinine Ratio is Associated with Carotid Atherosclerosis in a Community Based Cohort: Atherosclerosis Risk of Rural Area in Korean General Population Study

  • Sung, Joong-Kyung (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Kim, Jang-Young (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Youn, Young-Jin (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Jun-Won (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Ahn, Sung-Gyun (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Yoo, Byung-Su (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Lee, Seung-Hwan (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Yoon, Jung-Han (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Choe, Kyung-Hoon (Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine) ;
  • Yoon, Jin-Ha (Department of Preventive Medicine and Institute of Occupational Medicine, Yonsei University Wonju College of Medicine) ;
  • Park, Jong-Ku (Department of Preventive Medicine and Institute of Occupational Medicine, Yonsei University Wonju College of Medicine) ;
  • Koh, Sang-Baek (Department of Preventive Medicine and Institute of Occupational Medicine, Yonsei University Wonju College of Medicine)
  • Published : 2010.12.27

Abstract

Background: Albuminuria is a surrogate marker of endothelial dysfunction and a predictor of cardiovascular events. Data are limited with regard to the relationship between albuminuria and subclinical atherosclerosis in a community-based cohort. We determined the association between albuminuria measured by the urine albumin creatinine ratio (UACR) and carotid intima media thickness (CIMT) in a Korean rural population. Methods: We enrolled 1,369 healthy subjects older than 40 years (857 males and 518 females) with normal renal function and measured the CIMT. We excluded subjects with overt proteinuria (> 300 mg/day) or with treatment of diabetes mellitus, hypertension, dyslipidemia, and any cardiovascular disease. The subjects were stratified into the quartile value of the UACR (lowest quartile: UACR < 4.8 and highest quartile: UACR > 17.7). And we evaluate the relationship between UACR and CIMT by linear regression and logistic regression analysis. Results: Increasing quartile of the UACR had a stepwise increase in body mass index, blood pressure, cholesterol profile [low density lipoprotein (LDL)-cholesterol and triglyceride], glucose, homeostratic model assessment of insulin resistance (HOMA-IR), and C-reactive protein (all p values < 0.001). Maximal CIMT from the $1^{st}$ to the $4^{th}$ quartile values of the UACR were 0.74 ${\pm}$ 0.17, 0.77 ${\pm}$ 0.18, 0.78 ${\pm}$ 0.18, and 0.82 ${\pm}$ 0.21 mm, respectively (p < 0.001). In a multivariate regression model adjusted for age, sex, systolic blood pressure, triglyceride, LDL-cholesterol, fasting blood sugar, waist circumference, adiponectin, HOMA-IR, high sensitive C-reactive protein, smoking, UACR showed a significant association with maximal CIMT (B = 0.014, $R^2$ = 0.145, p = 0.002). Conclusion: Albuminuria measured by the UACR was significantly associated with both CIMT and traditional risk factors of atherosclerosis except for smoking in healthy Koreans.

Keywords

References

  1. Go AS, Chertow GM, Fan D, McCulloch CE, Hsu CY. Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N Engl J Med 2004;351:1296-305. https://doi.org/10.1056/NEJMoa041031
  2. Hillege HL, Fidler V, Diercks GF, van Gilst WH, de Zeeuw D, van Veldhuisen DJ, Gans RO, Janssen WM, Grobbee DE, de Jong PE; Prevention of Renal and Vascular End Stage Disease (PREVEND) Study Group. Urinary albumin excretion predicts cardiovascular and noncardiovascular mortality in general population. Circulation 2002;106:1777- 82. https://doi.org/10.1161/01.CIR.0000031732.78052.81
  3. Gerstein HC, Mann JF, Yi Q, Zinman B, Dinneen SF, Hoogwerf B, Halle JP, Young J, Rashkow A, Joyce C, Nawaz S, Yusuf S; HOPE Study Investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals. JAMA 2001; 286:421-6. https://doi.org/10.1001/jama.286.4.421
  4. Viberti GC, Hill RD, Jarrett RJ, Argyropoulos A, Mahmud U, Keen H. Microalbuminuria as a predictor of clinical nephropathy in insulindependent diabetes mellitus. Lancet 1982;1:1430-2.
  5. Arnlöv J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D, Benjamin EJ, D'Agostino RB, Vasan RS. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation 2005;112:969-75. https://doi.org/10.1161/CIRCULATIONAHA.105.538132
  6. Jorgensen L, Jenssen T, Johnsen SH, Mathiesen EB, Heuch I, Joakimsen O, Fosse E, Jacobsen BK. Albuminuria as risk factor for initiation and progression of carotid atherosclerosis in non-diabetic persons: the Tromso Study. Eur Heart J 2007;28:363-9. https://doi.org/10.1093/eurheartj/ehl394
  7. Furtner M, Kiechl S, Mair A, Seppi K, Weger S, Oberhollenzer F, Poewe W, Willeit J. Urinary albumin excretion is independently associated with carotid and femoral artery atherosclerosis in the general population. Eur Heart J 2005;26:279-87. https://doi.org/10.1093/eurheartj/ehi014
  8. Ruggenenti P, Gaspari F, Perna A, Remuzzi G. Cross sectional longitudinal study of spot morning urine protein: creatinine ratio, 24 hour urine protein excretion rate, glomerular filtration rate, and end stage renal failure in chronic renal disease in patients without diabetes. BMJ 1998; 316:504-9. https://doi.org/10.1136/bmj.316.7130.504
  9. O'Leary DH, Polak JF, Kronmal RA, Manolio TA, Burke GL, Wolfson SK Jr. Carotid-artery intima and media thickness as a risk factor for myocardial infarction and stroke in older adults. Cardiovascular health study collaborative research group. N Engl J Med 1999;340:14-22. https://doi.org/10.1056/NEJM199901073400103
  10. Mancia G, De Backer G, Dominiczak A, Cifkova R, Fagard R, Germano G, Grassi G, Heagerty AM, Kjeldsen SE, Laurent S, Narkiewicz K, Ruilope L, Rynkiewicz A, Schmieder RE, Struijker Boudier HA, Zanchetti A, Vahanian A, Camm J, De Caterina R, Dean V, Dickstein K, Filippatos G, Funck-Brentano C, Hellemans I, Kristensen SD, McGregor K, Sechtem U, Silber S, Tendera M, Widimsky P, Zamorano JL, Kjeldsen SE, Erdine S, Narkiewicz K, Kiowski W, Agabiti- Rosei E, Ambrosioni E, Cifkova R, Dominiczak A, Fagard R, Heagerty AM, Laurent S, Lindholm LH, Mancia G, Manolis A, Nilsson PM, Redon J, Schmieder RE, Struijker-Boudier HA, Viigimaa M, Filippatos G, Adamopoulos S, Agabiti-Rosei E, Ambrosioni E, Bertomeu V, Clement D, Erdine S, Farsang C, Gaita D, Kiowski W, Lip G, Mallion JM, Manolis AJ, Nilsson PM, O'Brien E, Ponikowski P, Redon J, Ruschitzka F, Tamargo J, van Zwieten P, Viigimaa M, Waeber B, Williams B, Zamorano JL, The task force for the management of arterial hypertension of the European Society of Hypertension, The task force for the management of arterial hypertension of the European Society of Cardiology. 2007 Guidelines for the management of arterial hypertension: The Task Force for the Management of Arterial Hypertension of the European Society of Hypertension (ESH) and of the European Society of Cardiology (ESC). Eur Heart J 2007;28:1462-536.
  11. Liu JE, Robbins DC, Palmieri V, Bella JN, Roman MJ, Fabsitz R, Howard BV, Welty TK, Lee ET, Devereux RB. Association of albuminuria with systolic and diastolic left ventricular dysfunction in type 2 diabetes: the Strong Heart Study. J Am Coll Cardiol 2003;41:2022-8. https://doi.org/10.1016/S0735-1097(03)00403-0
  12. Borch-Johnsen K, Feldt-Rasmussen B, Strandgaard S, Schroll M, Jensen JS. Urinary albumin excretion. An independent predictor of ischemic heart disease. Arterioscler Thromb Vasc Biol 1999;19:1992-7. https://doi.org/10.1161/01.ATV.19.8.1992
  13. Tuttle KR, Puhlman ME, Cooney SK, Short R. Urinary albumin and insulin as predictors of coronary artery disease: An angiographic study. Am J Kidney Dis 1999;34:918-25. https://doi.org/10.1016/S0272-6386(99)70051-X
  14. Agewall S, Bjorn F. Microalbuminuria and intima-media thickness of the carotid artery in clinically healthy men. Atherosclerosis 2002;164:161-6. https://doi.org/10.1016/S0021-9150(02)00056-4
  15. Jensen JS, Borch-Johnsen K, Jensen G, Feldt-Rasmussen B. Microalbuminuria reflects a generalized transvascular albumin leakiness in clinically healthy subjects. Clin Sci (Lond) 1995;88:629-33. https://doi.org/10.1042/cs0880629

Cited by

  1. Higher normal ranges of urine albumin-to-creatinine ratio are independently associated with carotid intima-media thickness vol.11, pp.None, 2010, https://doi.org/10.1186/1475-2840-11-112
  2. Low-grade albuminuria is associated with early but not late carotid atherosclerotic lesions in community-based patients with type 2 diabetes vol.12, pp.None, 2013, https://doi.org/10.1186/1475-2840-12-110
  3. Accelerated Atherosclerosis in Systemic Lupus Erythematosus: Role of Fibroblast Growth Factor 23- Phosphate Axis vol.14, pp.None, 2010, https://doi.org/10.2147/ijnrd.s326399