@article {863, title = {The association of microalbuminuria with clinical cardiovascular disease and subclinical atherosclerosis in the elderly: the Cardiovascular Health Study.}, journal = {Atherosclerosis}, volume = {187}, year = {2006}, month = {2006 Aug}, pages = {372-7}, abstract = {

PURPOSE: Microalbuminuria (MA) is a risk factor for cardiovascular disease (CVD). It is not known whether this association is due to the effect of MA on the development of subclinical atherosclerosis or whether MA destabilizes subclinical atherosclerosis, leading to clinical events.

METHODS: In a cross-sectional analysis we evaluated 3312 Cardiovascular Health Study participants, age >or=65 years, who had MA testing. Participants were divided into three groups: those without diabetes or hypertension (33\%), those with hypertension (52\%) and those with diabetes, with or without hypertension (15\%). Clinical CVD was defined as presence of coronary heart disease (angina, MI, CABG, PTCA), cerebrovascular disease (stroke, TIA) and peripheral arterial disease (requiring intervention). Among those without clinical disease, subclinical atherosclerosis was defined as increased carotid artery intima-media thickness, decreased ankle arm index or increased left ventricular mass.

RESULTS: In each of the three groups of participants, the adjusted odds of prevalent clinical CVD in the presence of MA was 1.70-1.80-fold increased, independent of other risk factors. MA was not associated with risk of subclinical atherosclerosis in those without hypertension or diabetes (OR 1.14 [95\% CI 0.59, 2.23]), whereas it was associated with subclinical atherosclerosis in those with hypertension (OR 1.58 [95\% CI 1.08, 2.30]) or diabetes (OR 2.51 [95\% CI 1.27, 4.94]).

CONCLUSION: In the absence of hypertension or diabetes, MA was associated with clinical CVD but not with subclinical atherosclerosis. Thus, a hypothesis may be made that the mechanism of association of MA with clinical vascular disease involves destabilization of the vasculature, leading to clinical disease.

}, keywords = {Aged, Aged, 80 and over, Albuminuria, Atherosclerosis, Cardiovascular Diseases, Coronary Disease, Diabetes Mellitus, Female, Humans, Hypertension, Male, Peripheral Vascular Diseases, Prevalence, Risk Factors, Stroke, United States}, issn = {0021-9150}, doi = {10.1016/j.atherosclerosis.2005.09.015}, author = {Cao, Jie J and Barzilay, Joshua I and Peterson, Do and Manolio, Teri A and Psaty, Bruce M and Kuller, Lewis and Wexler, Jason and Bleyer, Anthony J and Cushman, Mary} } @article {983, title = {Cardiovascular and mortality risk prediction and stratification using urinary albumin excretion in older adults ages 68-102: the Cardiovascular Health Study.}, journal = {Atherosclerosis}, volume = {197}, year = {2008}, month = {2008 Apr}, pages = {806-13}, abstract = {

BACKGROUND: Elevated urinary albumin excretion (UAE) is associated with the risk of cardiovascular disease (CVD) and all-cause mortality. We tested the hypothesis that elevated UAE improves cardiovascular risk stratification in an elderly cohort aged 68-102 years.

METHODS: We evaluated UAE in 3112 participants of the Cardiovascular Health Study who attended the 1996-1997 examination and had median follow up of 5.4 years. Elevated UAE was defined as urinary albumin to creatinine ratio > or =30 microg/mg. Microalbuminuria and macroalbuminuria were defined as urinary albumin to creatinine ratio 30-300 microg/mg and >300 microg/mg, respectively. Outcomes included CVD (myocardial infarction, stroke, cardiovascular death) and all-cause mortality. Cox proportional hazards models were used to assess the risk of outcomes associated with elevated UAE.

RESULTS: The prevalence of elevated UAE was 14.3\%, 17.1\% and 26.9\% in those aged 68-74, 75-84 and 85-102 years, respectively. CVD incidence and all-cause mortality were doubled (7.2\% and 8.1\% per year) in those with microalbuminuria and tripled (11.1\% and 12.3\% per year) in those with macroalbuminuria compared to those with normal UAE (3.3\% and 3.8\% per year). The increased CVD and mortality risks were observed in all age groups after adjustment for conventional risk factors. The adjusted population attributable risk percent of CVD and all-cause mortality for elevated UAE was 11\% and 12\%, respectively. When participants were cross-classified by UAE and Framingham Risk Score categories, the 5-year cumulative incidence of coronary heart disease among participants with elevated UAE and a 5-year predicted risk of 5-10\% was 20\%, substantially higher than 6.3\% in those with UAE <30m microg/mg.

CONCLUSION: Elevated UAE was associated with an increased risk of CVD and all-cause mortality in all age groups from 68 to 102 years. Combining elevated UAE with the Framingham risk scores may improve risk stratification for CVD in the elderly.

}, keywords = {Aged, Aged, 80 and over, Albuminuria, Biomarkers, Cohort Studies, Coronary Disease, Cross-Sectional Studies, Female, Health Surveys, Humans, Male, Predictive Value of Tests, Risk}, issn = {1879-1484}, doi = {10.1016/j.atherosclerosis.2007.07.029}, author = {Cao, Jie J and Biggs, Mary L and Barzilay, Joshua and Konen, Joseph and Psaty, Bruce M and Kuller, Lewis and Bleyer, Anthony J and Olson, Jean and Wexler, Jason and Summerson, John and Cushman, Mary} }