Cardiovascular risk factors are differently associated with urinary albumin excretion in men and women

Division of Nephrology, Department of Medicine, University Medical Center Groningen, Groningen University Institute of Drug Exploration (GUIDE), Hanzeplein 1, 9713 GZ Groningen, The Netherlands.
Journal of the American Society of Nephrology (Impact Factor: 9.34). 06/2003; 14(5):1330-5. DOI: 10.1097/01.ASN.0000060573.77611.73
Source: PubMed


Cardiovascular morbidity and mortality is not equally distributed among genders, men being more affected than women. It is not clear whether this is only related to a higher prevalence of the cardiovascular risk factors or to a similar prevalence of the risk factors as in women but a greater vascular susceptibility to these risk factors in men. This was tested by studying the association between various cardiovascular risk factors and urinary albumin excretion (UAE) in a large cohort of male and female subjects. While the prevalence of smoking and hypercholesterolemia was comparable between the genders, obesity was more common in women, and diabetes and hypertension were more frequent in men. The prevalence of microalbuminuria was about twofold higher in men. Interestingly, for a given level of any risk factor, UAE was higher in men than in women. On multivariate analysis with UAE as the dependent variable, an interaction with gender was found for the risk factors age, body mass index, and plasma glucose. Thus, for a higher age, body mass index, and glucose, the UAE is significantly increased in men when compared with women. It is concluded that gender differences exist in the association between cardiovascular risk factors and UAE. This is consistent with a larger vascular susceptibility to these risk factors in men as compared with women.

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    • "Currently, information about sex differences in renal abnormalities and CVD in healthy individuals is limited and conflicting. In the Prevention of Renal and Vascular End-Stage Disease (PREVEND) study, the prevalence of microalbuminuria in men was almost double that observed in women, and for a higher value of age and BMI was greater in men than in women [29]. In addition, the presence of CKD has been found to be associated with an increased risk of cardiovascular events [30] and of cardiovascular death [31] in both women and men having different degrees of cardiovascular risk or already having CVD. "
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    ABSTRACT: Background Although left ventricular hypertrophy (LVH) has been established as a predictor of cardiovascular events in chronic kidney disease (CKD), the relationship between the prevalence of LVH and CKD stage during the predialysis period has not been fully examined. Methods We measured left ventricular mass index (LVMI) in a cross-sectional cohort of participants in the Chronic Kidney Disease Japan Cohort (CKD-JAC) study in order to identify factors that are associated with increased LVMI in patients with stage 3–5 CKD. LVH was defined as LVMI > 125 g/m2 in male patients and >110 g/m2 in female patients. Results We analyzed baseline characteristics in 1185 participants (male 63.7 %, female 36.3 %). Diabetes mellitus was the underlying disease in 41.3 % of patients, and mean age was 61.8 ± 11.1 years. LVH was detected in 21.7 % of patients at baseline. By multivariate logistic analysis, independent risk factors for LVH were past history of cardiovascular disease (odds ratio [OR] 0.574; 95 % confidence interval [CI] 0.360–0.916; P = 0.020), systolic blood pressure (OR 1.179; 95 % CI 1.021–1.360; P = 0.025), body mass index (OR 1.135; 95 % CI 1.074–1.200; P < 0.001), and serum calcium level (OR 0.589; 95 % CI 0.396–0.876; P = 0.009). Conclusion Cross-sectional baseline data from the CKD-JAC study shed light on the association between LVH and risk factors in patients with decreased renal function. Further longitudinal analyses of the CKD-JAC cohort are needed to evaluate the prognostic value of LVH in CKD patients.
    Clinical and Experimental Nephrology 01/2013; 17(5). DOI:10.1007/s10157-012-0758-4 · 2.02 Impact Factor
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    • "This result support the idea that men and women with similar levels of cardiovascular risk factors may be expected to have similar risk of albuminuria. This has been shown by some prospective studies reporting that male sex does not increase the risk of progression to albuminuria, independent of the effect of other predictors [16-21], but is in contrast with the findings of PREVEND study which concluded that gender differences existed in the association between cardiovascular risk factors and UAE [22]. "
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    ABSTRACT: To study the prevalence and correlates of increased urinary albumin excretion (UAE) in an Iranian type 2 diabetic population. Over a one year period since October 2002, 400 consecutive type 2 diabetic patients referred to an outpatient diabetes clinic, were enrolled in a cross sectional study. Subjects had no history of renal impairment or overt proteinuria. Data concerning demographic characteristics and cardiovascular risk factors were recorded and height, weight and blood pressure were measured. Glucose, cholesterol, HDL-C, LDL-C, triglyceride, apoprotein B, lipoprotein a, creatinine, and HbA1c were measured in fasting blood samples. Overnight twelve-hour UAE were assessed by immunoturbidometry method. Regression analyses were employed to determine the correlates of UAE. Out of 400 patients, 156 (40%) subjects had increased UAE (UAE > or = 30 mg/24 hour). The UAE was higher in males compared to females (145.5 vs. 72.1 mg/day; p < 0.05); however, the age and HDL adjusted UAE levels were not significantly different between men and women (120.1 vs. and 87.9 mg/day; p = 0.37). Increased UAE was correlated with decreasing HDL-C and a longer duration of diabetes independent of other variables; increased UAE was correlated with HbA1c as well. Age, systolic and diastolic blood pressure, total cholesterol, LDL-C, triglyceride, apoprotein B, lipoprotein a, and GFR did not correlate with increased UAE. In this study, increased UAE was considerably frequent among type 2 diabetic patients without any significant history of renal dysfunction. Albuminuria was found to be associated with dyslipidemia (low HDL-C), long duration of diabetes, and uncontrolled glycemia revealed by higher HbA1c.
    Lipids in Health and Disease 08/2008; 7:28. DOI:10.1186/1476-511X-7-28 · 2.22 Impact Factor
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    ABSTRACT: Insulin resistance i s considered as a fundamental component of the pathogenesis of type 2 diabetes. People have suggested the possibility that treating and modifying insulin resistance in patients of type 2 diabetes would improve urine albumin excretion. This study was planned with an objective to investigate the relationship of insulin resistance with microalbuminuria in patients of type 2 diabetes mellitus and observe any difference between men and women in this association, in Pakistani population. This study was carried out and Diabetes clinic of Combined Military Hospital, Malir Cantt, from April 2007 to August 2007. One hundred and fifty five patients of type 2 diabetes mellitus were included in the study that had either microalbuminuria or normoalbuminuria. Body mass index, waist circumference and blood pressure were recorded. Fasting venous blood sample was collected for plasma glucose (FPG), serum insulin, total and HDL cholesterol, triglycerides, creatinine and HbA1c. Urine albumin excretion was determined using urine albumin to creatinine ratio. Insulin resistance was calculated from fasting plasma glucose and serum insulin levels, using homeostatic model assessment of insulin resistance (HOMA-IR). Microalbuminuria was found to be significantly correlated with HOMA-IR (r = 0.33, p = < 0.0001), serum insulin (r = 0.28, p = < 0.001), body mass index (r = 0.18, p = 0.02) and waist circumference (r = 0.21, p = 0.008). This correlation was more significant in women (n = 85, r = 0.48, p = < 0.0001) as compared to men (n = 70, r = 0.14, p = 0.12). The correlation between HOMA-IR and urine albumin excretion remained highly significant (p = 0.001) after controlling for gender, age, duration of diabetes, waist circumference, hypertension, triglycerides and HbA1c. 6 HOMA-IR was also significantly correlated with waistcircumference (r = 0.24, p = 0.001), BMI (r = 0.16, p = 0.02), triglycerides (r = 0.22, p = 0.003), HDL cholesterol (r = 0.18, p = 0.01), HbA1c (r = 0.35, p = < 0.0001), FPG (r = 0.44, p = < 0.0001) and metabolic syndrome (r = 0.18, p = 0.01) The study concludes that urine albumin excretion in patients of type 2 diabetes is strongly associated with insulin resistance and related cardiovascular risk factors. This association appears to be stronger in women than men, in our population.
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