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Microalbuminuria and arterial stiffness in a general population: the Shimanami Health Promoting Program (J-SHIPP)
Katsuhiko Kohara1, Yasuharu Tabara, Rieko Tachibana
1Department of Geriatric Medicine, Ehime University School of Medicine, Japan. koharak@m.ehime.u.ac.jp
Abstract:
Microalbuminuria is an early marker of renal damage and has been shown to predict future cardiovascular mortality and morbidity in patients with diabetes or hypertension, as well as in subjects in the general population. In this study, we investigated the hypothesis that the presence of microalbuminuria reflects the advancement of arterial stiffness by using a study group of 136 community residents who had no cardiovascular diseases except for hypertension and who were not taking any medications. Urinary albumin concentration was determined by the standard method and corrected by creatinine. Microalbuminuria was defined as a urinary albumin/creatinine ratio of 2.0-30.0 mg/mmol creatinine. Arterial stiffness was evaluated by pulse wave velocity (PWV) determined at three points: from the heart to the carotid artery, to the brachial artery, and to the ankle. Carotid arterial pressure was determined using a tonometric sensor. Carotid ultrasonography was performed to measure carotid intima-media thickness (IMT) and carotid arterial internal dimension. Subjects with microalbuminuria had higher blood pressure and wider pulse pressure not only in the brachial artery but also in the carotid artery. Microalbuminuria was associated with significantly higher PWV compared with that of normoalbuminuric subjects at all sites studied (mean PWV: 821.2+/-137.4 cm/s vs. 933.8+/-137.5 cm/s, p<0.0001). Stepwise regression analysis revealed that the presence of mircroalbuminuria (p=0.047) was a significant independent predictor of PWV in addition to age, sex, and systolic blood pressure. These findings suggest that microalbuminuria is associated with advanced atherosclerosis in the general population. Underlying arterial stiffness may explain the high cardiovascular mortality in subjects with microalbuminuria. Hypertension may be the mechanism linking microalbuminuria and arterial stiffness in the general population.
Insights
Microalbuminuria, an early sign of kidney damage, indicates advanced arterial stiffness and atherosclerosis in individuals with hypertension. This underlying stiffness may explain increased cardiovascular risk in these patients.
Area of Science:
- Cardiology
- Nephrology
- Vascular Biology
Background:
- Microalbuminuria is an established predictor of cardiovascular mortality in diabetic and hypertensive patients, and the general population.
- It serves as an early indicator of renal damage.
- The link between microalbuminuria and arterial stiffness in the general population requires further investigation.
Purpose of the Study:
- To investigate the hypothesis that microalbuminuria reflects advanced arterial stiffness.
- To examine the association between microalbuminuria and measures of arterial stiffness in a population without diagnosed cardiovascular disease.
Main Methods:
- A study of 136 community residents with hypertension but no other cardiovascular diseases.
- Measurement of urinary albumin-to-creatinine ratio to define microalbuminuria.
- Evaluation of arterial stiffness using pulse wave velocity (PWV) at multiple sites.
- Assessment of carotid artery parameters including intima-media thickness (IMT) and internal dimension.
Main Results:
- Subjects with microalbuminuria exhibited higher blood pressure and pulse pressure in both brachial and carotid arteries.
- Microalbuminuria was significantly associated with higher PWV across all measured arterial sites (p<0.0001).
- Microalbuminuria independently predicted PWV, alongside age, sex, and systolic blood pressure.
Conclusions:
- Microalbuminuria is linked to advanced atherosclerosis and arterial stiffness in the general population.
- Increased arterial stiffness may underlie the elevated cardiovascular mortality observed in individuals with microalbuminuria.
- Hypertension appears to be a key mechanism connecting microalbuminuria and arterial stiffness.
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