Urine Albumin Creatinine Ratio is Associated with Carotid Atherosclerosis in a Community Based Cohort: Atherosclerosis Risk of Rural Area in Korean General Population Study

Devision of Cardiology, Department of Internal Medicine, Yonsei University Wonju College of Medicine, Wonju, Korea.
Journal of cardiovascular ultrasound 12/2010; 18(4):134-8. DOI: 10.4250/jcu.2010.18.4.134
Source: PubMed


Albuminuria is a surrogate marker of endothelial dysfunction and a predictor of cardiovascular events. Data are limited with regard to the relationship between albuminuria and subclinical atherosclerosis in a community-based cohort. We determined the association between albuminuria measured by the urine albumin creatinine ratio (UACR) and carotid intima media thickness (CIMT) in a Korean rural population.
We enrolled 1,369 healthy subjects older than 40 years (857 males and 518 females) with normal renal function and measured the CIMT. We excluded subjects with overt proteinuria (> 300 mg/day) or with treatment of diabetes mellitus, hypertension, dyslipidemia, and any cardiovascular disease. The subjects were stratified into the quartile value of the UACR (lowest quartile: UACR < 4.8 and highest quartile: UACR > 17.7). And we evaluate the relationship between UACR and CIMT by linear regression and logistic regression analysis.
Increasing quartile of the UACR had a stepwise increase in body mass index, blood pressure, cholesterol profile [low density lipoprotein (LDL)-cholesterol and triglyceride], glucose, homeostratic model assessment of insulin resistance (HOMA-IR), and C-reactive protein (all p values < 0.001). Maximal CIMT from the 1(st) to the 4(th) quartile values of the UACR were 0.74 ± 0.17, 0.77 ± 0.18, 0.78 ± 0.18, and 0.82 ± 0.21 mm, respectively (p < 0.001). In a multivariate regression model adjusted for age, sex, systolic blood pressure, triglyceride, LDL-cholesterol, fasting blood sugar, waist circumference, adiponectin, HOMA-IR, high sensitive C-reactive protein, smoking, UACR showed a significant association with maximal CIMT (B = 0.014, R(2) = 0.145, p = 0.002).
Albuminuria measured by the UACR was significantly associated with both CIMT and traditional risk factors of atherosclerosis except for smoking in healthy Koreans.

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    • "No previous study has reported the cross-sectional association between the UACR values of normal range and CIMT in detail. There have been two previous studies that showed the similar results, but one study included subjects with microalbuminuria [19] and the other showed the UACR values according to CIMT thickening only [20]. "
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    ABSTRACT: Background High normal values of urine albumin-to-creatinine ratio (UACR) have been reported to have predictive values for hypertension, incident stroke, and higher mortality in the general population. This study aimed to investigate the association between normal ranges of UACR and carotid intima-media thickness (CIMT) in adult population. Methods We performed a cross-sectional study in adults aged 45 to 74 years who were living in Namwon City, South Korea. Both common CIMTs were measured, and mean values were calculated. Normal values of UACR were defined as <30mg/g and categorized into quintiles; less than 6.50, 6.51-9.79, 9.80-13.49, 13.50-18.89, and more than 18.90 mg/g. The association between the quintiles of UACR and common CIMT was analyzed and stratified by sex. Results A total of 7555 participants (3084 men and 4471 women) with normal UACR were enrolled in the present study. Common CIMT was positively and independently associated with increasing quintiles of UACR in men and women, even after adjusting for potential confounders including age and cardiovascular risk factors. Compared to the first quintile, the fifth quintile showed odds ratios of 1.80 (95% confidence intervals, 1.26-2.55) and 1.97 (1.28-3.04) for increased CIMT (>0.9mm) in men and women, respectively. Conclusion Higher UACR values within normal ranges (<30 mg/g) were positively and independently associated with CIMT in a Korean general population, suggesting that higher normal values of UACR might be a risk marker of subclinical carotid atherosclerosis.
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    Full-text · Article · Dec 2010 · Journal of cardiovascular ultrasound
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    ABSTRACT: To document the prevalence of albuminuria and determine its relationship to risk factors for cardiovascular disease (CVD) among Korean adults. We performed a cross-sectional study of adults aged 45-74 years from Namwon City, South Korea. Albuminuria was defined as a urinary albumin-to-creatinine ratio (UACR)≥30mg/g. The values of UACR were categorized into 5 groups: <10, 10-19, 20-29, 30-299, and ≥300mg/g. Risk factors for CVD and the estimated glomerular filtration rate (eGFR) were analyzed for an association with UACR values. Data were obtained from 10,534 participants (4140 men and 6394 women). Albuminuria was more prevalent among women than men (27.3% versus 22.7%, respectively, p<0.001), and it was also more prevalent among older participants (p<0.001). The prevalence of albuminuria was 36.3% among participants with hypertension or type 2 diabetes, and it was 16.6% among participants without these conditions. The UACR was positively associated with CVD risk factors, including blood pressure, obesity indexes, total cholesterol, and the eGFR. The prevalence of albuminuria is high in the general population in Korea, even among Koreans without CVD risk factors. Lower UACR values are associated with reduced CVD risk factors.
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