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Microalbuminuria: a common, independent cardiovascular risk factor, especially but not exclusively in type 2 diabetes.
J Hypertens Suppl 2003; 21(1):S7-12JH

Abstract

Microalbuminuria (defined as an albumin-creatinine ratio of 10-25 mg/mmol on the first-morning urine sample, or an albumin excretion rate of 20-200 microg/min on a timed collection) is present in 20-30% of all patients with type 2 diabetes, and is especially common in those with hypertension, endothelial dysfunction and other features of insulin resistance. Although microalbuminuria is predictive of worsening microvascular disease in the kidney (5-10% per year progress to overt diabetic nephropathy), an increased albumin excretion rate (AER) reflects a generalized abnormality of vascular function and is associated with 2-4-fold increases in cardiovascular and all-cause mortality. The extent to which microalbuminuria is a risk factor independent of other variables in type 2 diabetes, e.g. blood pressure and smoking, has been highlighted by recent cohort studies, e.g. the Heart Outcome Prevention Evaluation study and the Wisconsin Epidemiological Study of Diabetic Retinopathy. In the former study, for example, microalbuminuria at baseline increased the adjusted relative risks (RR) of a major cardiovascular event (RR 1.83), all-cause death (RR 2.09) and hospitalization for heart failure (RR 3.23) in both diabetic and non-diabetic subjects. These studies also highlighted that AER is a continuous risk factor, and that levels of AER below the arbitrary threshold for defining microalbuminuria are associated with relatively increased cardiovascular risk. Similarly, microalbuminuria affects 10-15% of middle-aged non-diabetics and is associated with coronary, peripheral and cerebral vascular complications. Detection of microalbuminuria, especially in type 2 diabetes, signifies the need to intensify blood pressure control as part of a multiple risk factor intervention strategy in a high-risk group. As hypertensive patients with type 2 diabetes are frequently treated by more than one antihypertensive agent, ACE inhibitors and low-dose diuretics are preferably recommended in order to provide sufficient blood pressure control and target organ protection.

Authors+Show Affiliations

School of Medical and Surgical Sciences, University of Nottingham, Southern Derbyshire Acute Hospitals Trust, Derby, UK. richard.donnelly@nottingham.ac.ukNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Research Support, Non-U.S. Gov't
Review

Language

eng

PubMed ID

12769161

Citation

Donnelly, Richard, et al. "Microalbuminuria: a Common, Independent Cardiovascular Risk Factor, Especially but Not Exclusively in Type 2 Diabetes." Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, vol. 21, no. 1, 2003, pp. S7-12.
Donnelly R, Yeung JM, Manning G. Microalbuminuria: a common, independent cardiovascular risk factor, especially but not exclusively in type 2 diabetes. J Hypertens Suppl. 2003;21(1):S7-12.
Donnelly, R., Yeung, J. M., & Manning, G. (2003). Microalbuminuria: a common, independent cardiovascular risk factor, especially but not exclusively in type 2 diabetes. Journal of Hypertension. Supplement : Official Journal of the International Society of Hypertension, 21(1), pp. S7-12.
Donnelly R, Yeung JM, Manning G. Microalbuminuria: a Common, Independent Cardiovascular Risk Factor, Especially but Not Exclusively in Type 2 Diabetes. J Hypertens Suppl. 2003;21(1):S7-12. PubMed PMID: 12769161.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Microalbuminuria: a common, independent cardiovascular risk factor, especially but not exclusively in type 2 diabetes. AU - Donnelly,Richard, AU - Yeung,Justin M C, AU - Manning,Gillian, PY - 2003/5/29/pubmed PY - 2004/1/6/medline PY - 2003/5/29/entrez SP - S7 EP - 12 JF - Journal of hypertension. Supplement : official journal of the International Society of Hypertension JO - J Hypertens Suppl VL - 21 IS - 1 N2 - Microalbuminuria (defined as an albumin-creatinine ratio of 10-25 mg/mmol on the first-morning urine sample, or an albumin excretion rate of 20-200 microg/min on a timed collection) is present in 20-30% of all patients with type 2 diabetes, and is especially common in those with hypertension, endothelial dysfunction and other features of insulin resistance. Although microalbuminuria is predictive of worsening microvascular disease in the kidney (5-10% per year progress to overt diabetic nephropathy), an increased albumin excretion rate (AER) reflects a generalized abnormality of vascular function and is associated with 2-4-fold increases in cardiovascular and all-cause mortality. The extent to which microalbuminuria is a risk factor independent of other variables in type 2 diabetes, e.g. blood pressure and smoking, has been highlighted by recent cohort studies, e.g. the Heart Outcome Prevention Evaluation study and the Wisconsin Epidemiological Study of Diabetic Retinopathy. In the former study, for example, microalbuminuria at baseline increased the adjusted relative risks (RR) of a major cardiovascular event (RR 1.83), all-cause death (RR 2.09) and hospitalization for heart failure (RR 3.23) in both diabetic and non-diabetic subjects. These studies also highlighted that AER is a continuous risk factor, and that levels of AER below the arbitrary threshold for defining microalbuminuria are associated with relatively increased cardiovascular risk. Similarly, microalbuminuria affects 10-15% of middle-aged non-diabetics and is associated with coronary, peripheral and cerebral vascular complications. Detection of microalbuminuria, especially in type 2 diabetes, signifies the need to intensify blood pressure control as part of a multiple risk factor intervention strategy in a high-risk group. As hypertensive patients with type 2 diabetes are frequently treated by more than one antihypertensive agent, ACE inhibitors and low-dose diuretics are preferably recommended in order to provide sufficient blood pressure control and target organ protection. SN - 0952-1178 UR - https://www.unboundmedicine.com/medline/citation/12769161/Microalbuminuria:_a_common_independent_cardiovascular_risk_factor_especially_but_not_exclusively_in_type_2_diabetes_ L2 - http://www.diseaseinfosearch.org/result/2243 DB - PRIME DP - Unbound Medicine ER -