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Impact of microalbuminuria on incident stroke: a meta-analysis
Meng Lee1, Jeffrey L Saver, Kuo-Hsuan Chang
1Stroke Center and Department of Neurology, University of California, Los Angeles, CA 90095, USA.
Background And Purpose:
Microalbuminuria, a marker of both kidney disease and endothelial dysfunction, may be associated with global vascular risk, but the nature and magnitude of the link between microalbuminuria and incident stroke has not been clearly defined. The purpose of this study was to assess the consistency and strength of the association of microalbuminuria with risk of stroke in prospective studies using meta-analysis.
Methods:
We conducted a systematic search of electronic databases and bibliographies for studies reporting a multivariate-adjusted estimate, represented as relative risk with 95% CI, of the association between microalbuminuria and stroke risk. Studies were excluded if a majority of study participants had established kidney disease or pre-eclampsia. Estimates were combined using a random-effect model.
Results:
We identified 12 studies, with a total of 48 596 participants and 1263 stroke events. Overall, presence of microalbuminuria was associated with greater stroke risk (relative risk, 1.92; 95% CI, 1.61 to 2.28; P < 0.001) after adjustment for established cardiovascular risk factors. There was evidence of significant heterogeneity in the magnitude of the association across studies (P for heterogeneity < 0.001, I² = 68%), which was partially explained by differences in study population, microalbuminuria definition, and different microalbuminuria-related risk among stroke subtypes. However, in stratified analyses, microalbuminuria was associated with increased risk of subsequent stroke in all subgroups (general population, diabetics, those with known stroke).
Conclusions:
Microalbuminuria is strongly and independently associated with incident stroke risk. Future studies should explore whether microalbuminuria is just a risk marker or a modifiable risk factor for stroke.
Insights
Microalbuminuria, an indicator of kidney disease, significantly increases stroke risk by nearly double. This association is strong and independent across diverse populations, highlighting its importance in vascular health.
Area of Science:
- Nephrology
- Neurology
- Cardiovascular Medicine
Background:
- Microalbuminuria signifies kidney disease and endothelial dysfunction.
- Its association with overall vascular risk is recognized.
- The specific link between microalbuminuria and incident stroke requires definition.
Purpose of the Study:
- To systematically evaluate the strength and consistency of microalbuminuria's association with stroke risk.
- To conduct a meta-analysis of prospective studies on microalbuminuria and stroke incidence.
Main Methods:
- Systematic literature search of electronic databases and bibliographies.
- Inclusion of studies reporting multivariate-adjusted relative risk (RR) with 95% CI for stroke.
- Exclusion of studies with prevalent kidney disease or pre-eclampsia; random-effects model for meta-analysis.
Main Results:
- 12 studies with 48,596 participants and 1263 stroke events were analyzed.
- Microalbuminuria showed a 1.92-fold increased stroke risk (95% CI, 1.61-2.28; P < 0.001) after risk factor adjustment.
- Heterogeneity was observed but microalbuminuria consistently elevated stroke risk across subgroups (general population, diabetics, prior stroke).
Conclusions:
- Microalbuminuria is a strong, independent predictor of incident stroke.
- Further research is needed to determine if microalbuminuria is a modifiable risk factor or merely a marker for stroke.
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