Urinary albumin excretion - An independent predictor of ischemic heart disease

Cross-sectional studies suggest that an increased urinary albumin excretion rate is associated with cardiovascular disease, dyslipidemia, and hyperten sion. The purpose of this study was to analyze prospectively whether the ur inary albumin-to -creatinine (A/C) ratio can independently predict ischemic heart disease (IHD) in a population-based cohort. In 1983, urinary albumin and creatinine levels were measured, along with the conventional atheroscl erotic risk factors, in 2085 consecutive participants without MD, renal dis ease, urinary tract infection, or diabetes mellitus. The participants were followed up until death, emigration, or December 31, 1993. IHD was defined as a hospital discharge diagnosis or cause of death including the diagnoses ICD-8 and 410 to 414. Seventy-nine individuals developed IHD during the 21 130 person-years of follow-up. They were characterized by a preponderance of males and higher age, body mass index, blood pressure, lipoproteins, and proportion of current smokers. Microalbuminuria was defined as an A/C rati o) >90 percentile (>0.65 mg/mmol). When adjusted for other risk factors, th e relative risk of MD associated with microalbuminuria was 2.3 (95% CI, 1.3 to 3.9, P=0.002), and the 10-year disease-free survival decreased from 97% to: 91% (P<0.0001) when microalbuminuria was present. An interaction betwe en microalbuminuria and smoking was observed, and the presence of microalbu minuria more than doubled the predictive effect of the conventional atheros clerotic risk factors for development of IHD. It is concluded that microalb uminuria is not only an independent predictor of IHD but also substantially increases the risk associated with other established risk factors.