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Cardiovascular and mortality risk prediction and stratification using urinary albumin excretion in older adults ages 68-102: the Cardiovascular Health Study.
Tuesday,2012-11-06 12:08 America/Los_Angeles — eenright
| Title | Cardiovascular and mortality risk prediction and stratification using urinary albumin excretion in older adults ages 68-102: the Cardiovascular Health Study. |
| Publication Type | Journal Article |
| Year of Publication | 2008 |
| Authors | Cao, JJ, Biggs, ML, Barzilay, J, Konen, J, Psaty, BM, Kuller, L, Bleyer, AJ, Olson, J, Wexler, J, Summerson, J, Cushman, M |
| Journal | Atherosclerosis |
| Volume | 197 |
| Issue | 2 |
| Pagination | 806-13 |
| Date Published | 2008 Apr |
| ISSN | 1879-1484 |
| 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 |
| Abstract | <p><b>BACKGROUND: </b>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.</p><p><b>METHODS: </b>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.</p><p><b>RESULTS: </b>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.</p><p><b>CONCLUSION: </b>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.</p> |
| DOI | 10.1016/j.atherosclerosis.2007.07.029 |
| Alternate Journal | Atherosclerosis |
| PubMed ID | 17875308 |
| Grant List | N01 HC-15103 / HC / NHLBI NIH HHS / United States N01-HC-35129 / HC / NHLBI NIH HHS / United States N01-HC-85079 / HC / NHLBI NIH HHS / United States N01-HC-85086 / HC / NHLBI NIH HHS / United States |