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Microalbuminuria in ischemic stroke
N B Beamer1, B M Coull, W M Clark
1Department of Neurology, Arizona Health Sciences Center, Tucson 85724-5023, USA.
Objectives:
To determine (1) the incidence of microalbuminuria in patients with recent ischemic stroke, (2) its relationship to risk factors for stroke, (3) its prevalence in the major subtypes of ischemic stroke, and (4) its potential for identifying patients at increased risk for recurrent stroke, myocardial infarction, or vascular death.
Design:
Prospective case-control study.
Setting:
Outpatient clinics at the medical centers affiliated with the Department of Veterans Affairs and Oregon Health Sciences University in Portland, Ore.
Patients:
A total of 186 older men and women (median age, 65 years) who were enrolled in a prospective study of risk factors for recurrent stroke, including 97 patients with recent (6-8 weeks) ischemic stroke, 51 with similar clinical risk factors for stroke, including 24 with a history of remote stroke or transient ischemic attack, and 38 community-dwelling volunteers.
Results:
Microalbuminuria was 3 times more prevalent in patients with recent stroke (29%) than in those with clinical risk factors for stroke (10%), and was undetectable in healthy elderly controls (P<.001). The presence of microalbuminuria in recent stroke as well as in the combined recent and remote stroke or transient ischemic attack group (n = 121) was predicted by diabetes (odds ratio [OR], 8.4; 95% confidence interval [CI], 2.6-27.0; P<.001; serum albumin levels (OR, 0.12; 95% CI, 0.03-0.50; P<.005); age (OR, 1.1; 95% CI, 1.0-1.2; P<.01), and ischemic heart disease (OR, 3.0; 95% CI, 1.0-9.1; P<.05). Among patients with recent stroke the prevalence of microalbuminuria did not differ among major ischemic stroke subtypes, ie, atheroembolic, 23%; cardioembolic, 30%; and lacunar, 33%. During a mean +/- SD of 1.5 +/- 0.9 years of follow-up, 20% of patients with recent stroke, 14% with risk factors for stroke, and 0% of healthy elderly volunteers had vascular end points (P<.004), with events being as frequent in patients with microalbuminuria (32%) as in patients with macroalbuminuria (33%). After controlling for major clinical risk factors, microalbuminuria remained an independently significant predictor of future stroke in the combined recent stroke and remote stroke or transient ischemic attack group (Cox proportional hazard ratio, 4.9; 95% CI, 1.4-17.6; P<.01).
Conclusions:
Microalbuminuria is a common finding in patients with cerebrovascular disease and is associated with increased risk for stroke even after correction for the presence of confounding clinical risk factors. These data suggest that microalbuminuria merits further examination as a potentially inexpensive and easily measured marker of increased risk for stroke.
Insights
Microalbuminuria, a marker of kidney damage, is common in stroke patients and predicts future vascular events. This finding suggests microalbuminuria can help identify individuals at higher risk for recurrent stroke or heart attack.
Area of Science:
- Nephrology
- Neurology
- Cardiology
Background:
- Microalbuminuria is an early sign of kidney damage.
- Its prevalence and predictive value in cerebrovascular disease are not fully understood.
Purpose of the Study:
- To determine the incidence of microalbuminuria in recent ischemic stroke patients.
- To assess its association with stroke risk factors and subtypes.
- To evaluate its potential in predicting recurrent vascular events.
Main Methods:
- A prospective case-control study involving 186 older adults.
- Included patients with recent ischemic stroke, those with clinical risk factors, and healthy controls.
- Follow-up for vascular events over a mean of 1.5 years.
Main Results:
- Microalbuminuria was 3 times more prevalent in recent stroke patients (29%) than in those with risk factors (10%).
- Diabetes, higher age, and ischemic heart disease predicted microalbuminuria.
- Microalbuminuria independently predicted future stroke (HR, 4.9).
Conclusions:
- Microalbuminuria is common in cerebrovascular disease.
- It is associated with an increased risk of stroke, independent of other risk factors.
- Microalbuminuria may serve as a valuable, inexpensive marker for identifying high-risk individuals.