Vorarlberg Institute for Vascular Investigation and Treatment, Feldkirch, Austria; Department of Medicine and Cardiology, Academic Teaching Hospital Feldkirch, Feldkirch, Austria; Private University in the Principality of Liechtenstein, Triesen, Principality of Liechtenstein.
Institute for Clinical Chemistry, Academic Teaching Hospital Feldkirch, Feldkirch, Austria.
Am J Cardiol. 2014 May 15;113(10):1616-20. doi: 10.1016/j.amjcard.2014.02.017. Epub 2014 Mar 1.
Albuminuria is an important indicator of cardiovascular risk. However, whether albuminuria predicts cardiovascular events independently of the baseline coronary artery state has not yet been investigated. We measured urinary albumin and creatinine concentrations in 867 consecutive patients who underwent coronary angiography for the evaluation of suspected or established stable coronary artery disease (CAD). Albuminuria was defined as a urinary albumin to creatinine ratio of 30 μg/mg or greater. Prospectively, we recorded the vascular events over 3.2 ± 1.2 years. From our patients, 318 had neither albuminuria nor significant CAD (i.e., coronary stenoses ≥ 50%) at baseline angiography, 69 had albuminuria but no significant CAD, 343 did not have albuminuria but significant CAD, and 137 had both albuminuria and significant CAD. Compared with the event rate among patients with neither albuminuria nor significant CAD (8.2%), event rates were significantly higher in patients with albuminuria without significant CAD (18.8%; p = 0.002) and in normoalbuminuric patients with significant CAD (19.2%; p <0.001); it was highest in patients with both albuminuria and significant CAD (33.6%; p <0.001). Importantly, event rates were similar in patients with albuminuria free of significant CAD and those with significant CAD but normoalbuminuria (p = 0.767). In conclusion, this is the first study demonstrating that albuminuria per se is a CAD risk equivalent after adjusting for the angiographically proven atherosclerotic state at baseline.
尿白蛋白是心血管风险的一个重要指标。然而，尿白蛋白是否在基线冠状动脉状态之外独立预测心血管事件尚未得到研究。我们测量了 867 例连续接受冠状动脉造影检查以评估疑似或已确诊的稳定型冠状动脉疾病（CAD）的患者的尿白蛋白和肌酐浓度。尿白蛋白定义为尿白蛋白与肌酐比值≥30μg/mg。前瞻性地，我们记录了 3.2±1.2 年的血管事件。我们的患者中，318 例基线造影时既无白蛋白尿也无明显 CAD（即冠状动脉狭窄≥50%），69 例有白蛋白尿但无明显 CAD，343 例无白蛋白尿但有明显 CAD，137 例既有白蛋白尿又有明显 CAD。与既无白蛋白尿又无明显 CAD 的患者（8.2%）相比，无明显 CAD 的白蛋白尿患者（18.8%；p=0.002）和无明显 CAD 的正常白蛋白尿患者（19.2%；p<0.001）的事件发生率显著更高；而既有白蛋白尿又有明显 CAD 的患者（33.6%；p<0.001）的事件发生率最高。重要的是，无明显 CAD 的白蛋白尿患者和有明显 CAD 但正常白蛋白尿患者的事件发生率相似（p=0.767）。总之，这是第一项研究表明，在调整基线时经血管造影证实的动脉粥样硬化状态后，白蛋白尿本身就是 CAD 的等效风险。
