microalbuminuria and cardiovascular (CV) risk

Last reviewed 10/2023

There is evidence from the HOPE study that the presence of albuminuria indicates increased risk for myocardial infarction, stroke, cardiovascular death, congestive heart failure, and all-cause mortality.

Summary results:

• the association between albuminuria and increaed cardiovascular risk is true in patients with or without diabetes and, in the HOPE study, occurred in those receiving ramipril or placebo
• the increase in risk began below the threshold concentrations for microalbuminuria used to indicate incipient diabetic nephropathy in patients with diabetes mellitus (albumin/creatinine ratio of below 2mg/mmol)

  outcomes at median 4.5 years	with microalbuminuria	without microalbuminuriaa	adjusted RR (95% CI)
  major cardiovascular events	23%	14%	1.83 (1.64-2.05)
  all-cause mortality	18%	9%	2.09 (1.84-2.38)
  CHF hospital admission	6%	2%	3.23 (2.54-4.10)

Authors of the study point out that many cardiovascular risk factors are associated with microalbuminuria, including smoking, hypertension, dyslipidaemia, hyperhomocystinemia, dietary protein, and markers of acute phase response. There is a need for further research to clearly assess the independent cardiovascular risk that occurs as a result of the presence (and degree) of albuminuria.

Glomerular Filtration and microalbuminuria:

• evidence from a Norwegian cohort study reveals that the combination of a glomerular filtration rate < 45 ml/min/1.73m^2 and microalbuminuria was a strong predictor of cardiovascular death (2)
  • reduced kidney function and microalbuminuria were risk factors for cardiovascular death, independent of each other and traditional risk factors
• a US study revealed that moderately decreased estimated GFR and albuminuria independently predict cardiovascular and all-cause mortality in the general population (3)

Reference:

• (1) Gerstein HG et al, for the HOPE study investigators. Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and non-diabetic individuals. JAMA 2001;286:421-6.
• (2) Hallan S et al. Association of kidney function and albuminuria with cardiovascular mortality in older vs younger individuals: The HUNT II Study. Arch Intern Med. 2007 Dec 10;167(22):2490-6.
• (3) Astor BC et al. Glomerular filtration rate, albuminuria, and risk of cardiovascular and all-cause mortality in the US population. Am J Epidemiol. 2008 May 15;167(10):1226-34