Original Investigation: Pathogenesis and Treatment of Kidney Disease and Hypertension
The relationship of cardiovascular risk factors to microalbuminuria in older adults with or without diabetes mellitus or hypertension: the cardiovascular health study

https://doi.org/10.1053/j.ajkd.2004.03.022Get rights and content

Abstract

Background:Microalbuminuria is a risk factor for coronary heart disease (CHD). It occurs most commonly in the settings of diabetes and hypertension. The mechanisms by which it increases CHD risk are uncertain. Methods:We examined the cross-sectional association of microalbuminuria with a broad range of CHD risk factors in 3 groups of adults aged 65 years or older with and without microalbuminuria: those with (1) no diabetes or hypertension (n = 1,098), (2) hypertension only (n = 1,450), and (3) diabetes with or without hypertension (n = 465). Results:Three factors were related to microalbuminuria in all 3 groups: age, elevated systolic blood pressure, and markers of systemic inflammation. In patients with neither diabetes nor hypertension, increasing C-reactive protein levels were associated with microalbuminuria (odds ratio per 1-mg/L increase, 1.46; 95% confidence interval [CI], 1.15 to 1.84). Among those with diabetes, an increase in white blood cell (WBC) count was associated with microalbuminuria (odds ratio per 1,000-cell/mL increase, 2.57; 95% CI, 1.12 to 5.89). Among those with hypertension, an increase in WBC count (odds ratio per 1,000-cell/mL increase, 1.83; 95% CI, 1.04 to 3.23) and fibrinogen level (odds ratio per 10-mg/dL increase, 1.02; 95% CI, 1.00 to 1.05) were significantly associated with microalbuminuria. In all 3 groups, prevalent CHD was related to an elevated WBC count. In none of the 3 groups was brachial artery reactivity to ischemia, an in vivo marker of endothelial function, related to microalbuminuria. Conclusion:Microalbuminuria is associated with age, systolic blood pressure, and markers of inflammation. These associations reflect potential mechanisms by which microalbuminuria is related to CHD risk.

Section snippets

Methods

Recruitment methods for the CHS have been published.19 In brief, a random sample of individuals aged 65 years or older derived from Medicare eligibility lists and their spouses were invited to participate at 4 field centers. Potential participants were excluded if they had cancer under active treatment or would not have been able to attend a field center for examination. A total of 5,201 participants were recruited in 1989 to 1990 (called the original cohort), and 687 participants in 1992 to

Results

Albuminuria status, categorized by the presence or absence of diabetes and/or hypertension, is listed in Table 1. Microalbuminuria was present in 15.9% of the cohort; 7.7% of those with neither hypertension nor diabetes, 16.7% of those with hypertension only, and 31.2% of those with diabetes with or without hypertension. Subjects with macroalbuminuria were excluded from additional analyses.

Discussion

In this study, microalbuminuria was associated with elevated levels of several inflammatory factors in the presence or absence of hypertension or diabetes. The association of inflammatory factors with microalbuminuria also was present regardless of whether CVD, which may increase levels of inflammatory factors, was present. Many of the same inflammatory factors associated with microalbuminuria also were associated with CHD. Together, these results suggest an association between

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    Supported in part by contracts no. NO1-HC-85079 through NO1-HC-85086, NO1-HC-35129, and NO1-HC-15103 from the National Heart, Lung, and Blood Institute.

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