Arnlöv Johan, Evans Jane C, Meigs James B, Wang Thomas J, Fox Caroline S, Levy Daniel, Benjamin Emelia J, D'Agostino Ralph B, Vasan Ramachandran S
Framingham Heart Study, National Heart, Lung and Blood Institute, Bethesda, MD, USA.
Circulation. 2005 Aug 16;112(7):969-75. doi: 10.1161/CIRCULATIONAHA.105.538132. Epub 2005 Aug 8.
Data are limited with regard to the relations of low-grade albuminuria (below the microalbuminuria threshold) and incidence of cardiovascular disease (CVD) events in nondiabetic, nonhypertensive individuals.
We examined the association of urinary albumin excretion (spot urine albumin indexed to creatinine [UACR]) and the incidence of CVD events and all-cause mortality in 1568 nonhypertensive, nondiabetic Framingham Offspring Study participants (mean age, 55 years; 58% women) free of CVD. On follow-up (median, 6 years), 54 participants (20 women) developed a first CVD event, and 49 (19 women) died. After adjustment for established risk factors, increasing UACR was associated with greater risk of CVD (hazards ratio [HR] per SD increment in log UACR, 1.36; 95% CI, 1.00 to 1.87) and death (HR per SD increment in log UACR, 1.55; 95% CI, 1.10 to 2.20). Participants with UACR greater than or equal to the sex-specific median (> or =3.9 microg/mg for men, > or =7.5 microg/mg for women) experienced a nearly 3-fold risk of CVD (adjusted HR, 2.92; 95% CI, 1.57 to 5.44; P<0.001) and a borderline significantly increased risk of death (adjusted HR, 1.75; 95% CI, 0.95 to 3.22; P=0.08) compared with those with UACR below the median. The increased CVD risk associated with UACR at or above the median remained robust in analyses restricted to individuals without microalbuminuria (n=1470) and in subgroups with intermediate (n=1469) and low (n=1186) pretest probabilities of CVD.
In our community-based sample of middle-aged nonhypertensive, nondiabetic individuals, low levels of urinary albumin excretion well below the current microalbuminuria threshold predicted the development of CVD. Our observations add to the growing body of evidence that challenges the notion that UACR <30 microg/mg indicates "normal" albumin excretion.
关于非糖尿病、非高血压个体中低级别白蛋白尿（低于微量白蛋白尿阈值）与心血管疾病（CVD）事件发生率之间的关系，数据有限。
我们在1568名无CVD的非高血压、非糖尿病弗明汉后代研究参与者（平均年龄55岁；58%为女性）中，研究了尿白蛋白排泄量（以肌酐为指标的随机尿白蛋白[UACR]）与CVD事件发生率及全因死亡率之间的关联。在随访（中位数为6年）期间，54名参与者（20名女性）发生了首次CVD事件，49名（19名女性）死亡。在对既定风险因素进行调整后，UACR升高与CVD风险增加（log UACR每增加1个标准差的风险比[HR]为1.36；95%CI为1.00至1.87）及死亡风险增加（log UACR每增加1个标准差的HR为1.55；95%CI为1.10至2.20）相关。UACR大于或等于性别特异性中位数（男性≥3.9微克/毫克，女性≥7.5微克/毫克）的参与者，与UACR低于中位数的参与者相比，发生CVD的风险增加近3倍（调整后HR为2.92；95%CI为1.57至5.44；P<0.001），死亡风险有临界显著增加（调整后HR为1.75；95%CI为0.95至3.22；P=0.08）。在仅限于无微量白蛋白尿的个体（n = 1470）以及CVD预测试概率为中等（n = 1469）和低（n = 1186）的亚组分析中，与UACR处于或高于中位数相关的CVD风险增加仍然显著。
在我们基于社区的中年非高血压、非糖尿病个体样本中，远低于当前微量白蛋白尿阈值的低水平尿白蛋白排泄量可预测CVD的发生。我们的观察结果进一步增加了越来越多的证据，对UACR<30微克/毫克表示“正常”白蛋白排泄这一观念提出了挑战。
