Microalbuminuria in ischemic stroke

Objectives: To determine (1) the incidence of microalbuminuria in patients with recent ischemic stroke, (2) its relationship to risk factors for strok e, (3) its prevalence in the major subtypes of ischemic stroke, and (4) its potential for identifying patients at increased risk for recurrent stroke, myocardial infarction, or vascular death. Design: Prospective case-control study. Setting: Outpatient clinics at the medical centers affiliated with the Depa rtment of Veterans Affairs and Oregon Health Sciences University in Portlan d, Ore. Patients: A total of 186 older men and women (median age, 65 years) who wer e enrolled in a prospective study of risk factors for recurrent stroke, inc luding 97 patients with recent (6-8 weeks) ischemic stroke, 51 with similar clinical risk factors for stroke, including 24 with a history of remote st roke or transient ischemic attack, and 38 community-dwelling volunteers. Results: Microalbuminuria was 3 times more prevalent in patients with recen t stroke (29%) than in those with clinical risk factors for stroke (10%), a nd was undetectable in healthy elderly controls (P<.001). The presence of m icroalbuminuria in recent stroke as well as in the combined recent and remo te stroke or transient ischemic attack group (n=121) was predicted by diabe tes (odds ratio [OR], 8.4; 95% confidence interval [CI], 2.6-27.0; P<.001; serum albumin levels (OR, 0.12; 95% CI, 0.03-0.50; P<.005); age (OR, 1.1; 9 5% CI, 1.0-1.2; P<.01), and ischemic heart disease (OR, 3.0; 95% CI, 1.0-9. 1; P.05). Among patients with recent stroke the prevalence of microalbuminu ria did not differ among major ischemic stroke subtypes, ie, atheroembolic, 23%; cardioembolic, 30%; and lacunar, 33%. During a mean +/- SD of 1.5 +/- 0.9 years of follow-up, 20% of patients with recent stroke, 14% with risk factors for stroke, and 0% of healthy elderly volunteers had vascular end p oints (P<.004), with events being as frequent in patients with microalbumin uria (32%) as in patients with macroalbuminuria (33%). After controlling fo r major clinical risk factors, microalbuminuria remained an independently s ignificant predictor of future stroke in the combined recent stroke and rem ote stroke or transient ischemic attack group (Cox proportional hazard rati o, 4.9; 95% CI, 1.4-17.6; P<.01). Conclusions: Microalbuminuria is a common finding in patients with cerebrov ascular disease and is associated with increased risk for stroke even after correction for the presence of confounding clinical risk factors. These da ta suggest that microalbuminuria merits further examination as a potentiall y inexpensive and easily measured marker of increased risk for stroke.