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Lu YW, Chang CC, Chou RH, Tsai YL, Liu LK, Chen LK, Huang PH, Lin SJ. Sex difference in the association between pathological albuminuria and subclinical atherosclerosis: insights from the I-Lan longitudinal aging study. Aging (Albany NY) 2022; 14:8001-8012. [PMID: 36227142 PMCID: PMC9596222 DOI: 10.18632/aging.204331] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2022] [Accepted: 09/23/2022] [Indexed: 11/25/2022]
Abstract
Background: Pathological albuminuria (PAU) (urinary albumin creatinine ratio [UACR] ≥30 mg/g) is an independent risk factor of cardiovascular disease. PAU is more prevalent in men than women. We aimed to compare the association of PAU and the early phase of subclinical atherosclerosis (SA) between sexes. Methods: 1228 subjects aged 50–90 years were stratified by sex and UACR (normal or PAU). SA was defined as mean carotid intima-media thickness ≥75th percentile of the cohort. Demographics and SA prevalence were compared between groups. Multivariate logistic regression was performed to assess the relationship between PAU and SA. Results: Both men and women with PAU had increased prevalence of hypertension, anti-hypertensive therapy, and metabolic syndrome than controls. Men with PAU were older and had greater waist circumference and total body fat percentage. Sex disparity was observed in associations between waist-to-height ratio, total body fat, and UACR. After adjusting for traditional risk factors, multivariate logistic regression disclosed that PAU was independently associated with SA in men (adjusted odds ratio 1.867, 95% CI 1.066–3.210) but not in women. Conclusion: The relationship of PAU and SA differed between sexes. This result may highlight the need for sex-specific risk management strategies to prevent atherosclerosis.
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Affiliation(s)
- Ya-Wen Lu
- Division of Cardiology, Department of Medicine, Taichung Veterans General Hospital, Taichung, Taiwan.,Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Chun-Chin Chang
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Ruey-Hsing Chou
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Yi-Lin Tsai
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Li-Kuo Liu
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan
| | - Liang-Kung Chen
- Center for Geriatrics and Gerontology, Taipei Veterans General Hospital, Taipei, Taiwan.,Aging and Health Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Public Health, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan
| | - Po-Hsun Huang
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Department of Critical Care Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
| | - Shing-Jong Lin
- Cardiovascular Research Center, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Institute of Clinical Medicine, National Yang Ming Chiao Tung University, Taipei, Taiwan.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Taipei Municipal Gan-Dau Hospital, Taipei, Taiwan.,Taipei Heart Institute, Taipei Medical University, Taipei, Taiwan.,Division of Cardiology, Heart Center, Cheng-Hsin General Hospital, Taipei, Taiwan
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A Higher Fructose Intake Is Associated with Greater Albuminuria in Subjects with Type 2 Diabetes Mellitus. Int J Nephrol 2018; 2018:5459439. [PMID: 30416829 PMCID: PMC6207863 DOI: 10.1155/2018/5459439] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/17/2018] [Revised: 08/30/2018] [Accepted: 09/25/2018] [Indexed: 11/24/2022] Open
Abstract
The aim of this single center cross-sectional study was to investigate the association between fructose intake and albuminuria in subjects with type 2 diabetes mellitus (T2DM). This is a single center cross-sectional study. One hundred and forty-three subjects with T2DM were recruited from the Instituto Nacional de Ciencias Medicas y Nutricion Salvador Zubiran. The median daily fructose intake was estimated with a prospective food registry during 3 days (2 week-days and one weekend day) and they were divided into low fructose intake (<25 g/day) and high fructose intake (≥ 25 g/day). Complete clinical and biochemical evaluations were performed, including anthropometric variables and a 24-hour urine collection for albuminuria determination. One hundred and thirty-six subjects were analyzed in this study. We found a positive significant association between daily fructose intake and albuminuria (ρ= 0.178, p=0.038) in subjects with type 2 diabetes mellitus. Other variables significantly associated with albuminuria were body mass index (BMI) (ρ= 0.170, p=0.048), mean arterial pressure (MAP) (ρ= 0.280, p=0.001), glycated hemoglobin (A1c) (ρ= 0.197, p=0.022), and triglycerides (ρ= 0.219, p=0.010). After adjustment for confounding variables we found a significant and independent association between fructose intake and albuminuria (β= 13.96, p=0.006). We found a statistically significant higher albuminuria (60.8 [12.8-228.5] versus 232.2 [27.2-1273.0] mg/day, p 0.002), glycated hemoglobin (8.6±1.61 versus 9.6±2.1 %), p= 0.003, and uric acid (6.27±1.8 versus 7.2±1.5 mg/dL), p=0.012, in the group of high fructose intake versus the group with low fructose intake, and a statistically significant lower creatinine clearance (76.5±30.98 mL/min versus 94.9±36.8, p=0.014) in the group with high fructose intake versus the group with low fructose intake. In summary we found that a higher fructose intake is associated with greater albuminuria in subjects with T2DM.
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Choi SW, Han SW, Ok JS, Yoo BS, Shin MS, Park SH, Ryu KH. A multicenter cohort study of primary hypertension in Korea: study design and interim analysis of the Korean registry of target organ damage in hypertension (KorHR). Clin Hypertens 2017; 23:16. [PMID: 28794898 PMCID: PMC5540578 DOI: 10.1186/s40885-017-0072-2] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2017] [Accepted: 06/12/2017] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND The Korean Registry of Target Organ Damage in Hypertension aims to evaluate the clinical characteristics and prevalence of subclinical target organ damage in Korean hypertensive patients. METHOD This is a prospective, observational, multicenter cohort study in which 23 university hospitals participated. Since May 2013, we have enrolled 1,318 consecutive hypertensive patients without known cardiovascular disease who met the following inclusion criteria: 1) age older than 30 years and 2) the first visit to the participating hospitals was within the last 5 years. RESULTS The mean age was 52 ± 12 years; 62.1% were male, and 41.3% were incident hypertensives. Patients with diabetes mellitus accounted for 7.8% of the population and 43.8% had hyperlipidemia or were on statins at baseline. The mean office blood pressures were 152 ± 20/96 ± 14 mmHg for incident hypertensive patients and 129 ± 13/78 ± 10 mmHg for patients on treatment. Patients with electrocardiographic and echocardiographic left ventricular hypertrophy accounted for 18.9 and 25.6%, respectively. The mean brachial-ankle pulse wave velocity (PWV) was 1564 ± 293 m/s and 19.5% had PWV values of more than 1750 cm/s. Patients with microalbuminuria and chronic kidney disease accounted for 21 and 4%, respectively. The first prescribed class of antihypertensive medications was angiotensin converting enzyme inhibitors in 2.9%, angiotensin receptor blockers (ARBs) in 57.5%, diuretics in 7.6%, calcium channel blockers (CCBs) in 61.0%, beta blockers in 17.3%, and fixed dose combination pill in 27.8%. CONCLUSION Our interim analysis shows that subclinical target organ damage in hypertension is considerably present for incident or treated hypertensive patients. CCBs and ARBs were the most commonly prescribed classes of antihypertensive medications and fixed dose combination pills were actively used in Korea. TRIAL REGISTRATION NCT01861080. Registered 16 May 2013.
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Affiliation(s)
- Suk-Won Choi
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University, 7 Keunjaebong-Gil, Hwaseong, Gyeonggido 18450 South Korea
| | - Seong Woo Han
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University, 7 Keunjaebong-Gil, Hwaseong, Gyeonggido 18450 South Korea
| | - Jong Sun Ok
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University, 7 Keunjaebong-Gil, Hwaseong, Gyeonggido 18450 South Korea
| | - Byung-Su Yoo
- Division of Cardiology, Department of Internal Medicine, Yonsei University Wonju Severance Christian Hospital, Wonju, South Korea
| | - Mi-Seung Shin
- Division of Cardiology, Department of Internal Medicine, Gachon University Gil Medical Center, Incheon, South Korea
| | - Sung Ha Park
- Division of Cardiology, Department of Internal Medicine, Severance Cardiovascular Hospital, Seoul, South Korea
| | - Kyu-Hyung Ryu
- Division of Cardiology, Department of Internal Medicine, Dongtan Sacred Heart Hospital, Hallym University, 7 Keunjaebong-Gil, Hwaseong, Gyeonggido 18450 South Korea
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Chen S, Chen Y, Liu X, Li M, Wu B, Li Y, Liang Y, Shao X, Holthöfer H, Zou H. Association of insulin resistance with chronic kidney disease in non-diabetic subjects with normal weight. PLoS One 2013; 8:e74058. [PMID: 24058515 PMCID: PMC3772877 DOI: 10.1371/journal.pone.0074058] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/22/2013] [Accepted: 07/27/2013] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVE To the best of our knowledge, the association of insulin resistance (IR) with chronic kidney disease (CKD) has not been well studied in normal-weight individuals. The aim of this study is to examine whether IR is associated with CKD in non-diabetic subjects with normal weight. We also examine whether the presence of obesity modifies the association of IR with CKD. METHODS Data were drawn from a cross-sectional survey in China. Both estimated glomerular filtration rate and urinary albumin to creatinine ratio were used as markers of CKD. Logistic regression models and the quartiles of homeostatic model assessment of insulin resistance were used to explore the associations of IR with CKD in entire cohort, normal-weight and overweight/obese subpopulations. RESULTS In normal-weight subpopulation, the prevalence of IR and metabolic syndrome were 11.11% and 8.99%, respectively. In the entire cohort, the highest quartile HOMA-insulin resistance had a 70% increased risk for CKD (RR 1.70, 95% CI 1.07, 2.71, P=0.03, comparing the highest to the lowest quartile). However, when adding obesity to the model, the association was abolished. IR was associated with CKD in overweight/obese subpopulation but not in normal-weight subpopulation. CONCLUSION IR and MetS in normal-weight individuals is common in the Chinese population. IR is associated with CKD in overweight/obese subpopulation but not in normal-weight subpopulation and the presence of obesity modifies the association of IR with CKD.
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Affiliation(s)
- Shanying Chen
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Youming Chen
- Clinical Laboratory, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xinyu Liu
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Mi Li
- Blood purification center, No. 5 Affiliated Hospital of Sun Yat-sen University, Zhuhai, Guangdong, China
| | - Bide Wu
- Department of Nephrology, Zhangzhou Affiliated Hospital of Fujian Medical University, Zhangzhou, Fujian, China
| | - Yongqiang Li
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Yan Liang
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Xiaofei Shao
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
| | - Harry Holthöfer
- National Centre for Sensor Research/BioAnalytical Sciences, Dublin City University, Dublin, Ireland
| | - Hequn Zou
- Department of Nephrology, Third Affiliated Hospital of Southern Medical University, Guangzhou, Guangdong, China
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Urinary albumin excretion is a risk factor for diabetes mellitus in men, independently of initial metabolic profile and development of insulin resistance. The DESIR Study. J Hypertens 2008; 26:2198-206. [DOI: 10.1097/hjh.0b013e328310ddff] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
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Gardin JM, Allebban Z, Wong ND, Sklar SK, Bess RL, Spence MA, Pershadsingh HA. Endothelial function and urine albumin levels among asymptomatic Mexican-Americans and non-Hispanic whites. Cardiovasc Ultrasound 2008; 6:43. [PMID: 18752679 PMCID: PMC2542998 DOI: 10.1186/1476-7120-6-43] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/24/2008] [Accepted: 08/27/2008] [Indexed: 11/12/2022] Open
Abstract
Background- Mexican-Americans (MA) exhibit increases in various cardiovascular disease (CVD) risk factors compared to non-Hispanic Whites (NHW), yet are reported to have lower CVD mortality rates. Our aim was to help explain this apparent paradox by evaluating endothelial function and urine albumin levels in MA and NHW. Methods- One hundred-five MA and 100 NHW adults were studied by brachial artery flow-mediated dilatation (FMD), blood and urine tests. Participants were studied by ultrasound-determined brachial artery flow-mediated dilatation (FMD), blood and urine tests, at a single visit. Results- Despite higher BMI and triglycerides in MA, MA demonstrated higher FMD than did NHW (9.1 ± 7.3% vs. 7.1 ± 6.3%, p < 0.04). Among MA, urinary albumin was consistently lower in participants with FMD ≥ 7% FMD versus < 7% FMD (p < 0.006). In multivariate analyses in MA men, urinary albumin was inversely related to FMD (r = -0.26, p < 0.05), as were BMI and systolic blood pressure. In MA women, urinary albumin:creatinine ratio was an independent inverse predictor of FMD (p < 0.05 ). Conclusion- To our knowledge, this is the first study to analyze, in asymptomatic adults, the relation of MA and NHW ethnicity to FMD and urine albumin levels. The findings confirm ethnic differences in these important subclinical CVD measures.
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Affiliation(s)
- Julius M Gardin
- Division of Cardiology, Department of Medicine, St, John Hospital & Medical Center, Detroit, MI 48236, USA.
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7
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Roland M, Gatault P, Al-Najjar A, Doute C, Barbet C, Chatelet V, Laouad I, Marlière JF, Nivet H, Büchler M, Lebranchu Y, Halimi JM. Early pulse pressure and low-grade proteinuria as independent long-term risk factors for new-onset diabetes mellitus after kidney transplantation. Am J Transplant 2008; 8:1719-28. [PMID: 18694475 DOI: 10.1111/j.1600-6143.2008.02308.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/25/2023]
Abstract
Risk factors for new-onset diabetes after transplantation (NODAT) need to be assessed in large cohorts. We retrospectively evaluated the impact of early (3 and 6 months after transplantation) proteinuria, urinary albumin excretion (UAE) and arterial pressure on NODAT in 828 Caucasian renal transplant recipients (median follow-up: 5.3 years; 5832 patient-years). The 10- and 20-year incidence of NODAT was 15.0% and 22.0%, respectively. Low-grade (<1 g/day) (HR: 2.04 [1.25-3.33], p = 0.0042) and very low-grade (<0.3 g/day) (HR: 2.21 [1.32-3.70], p = 0.0025) proteinuria were independent risk factors for NODAT. There was a dose-dependent relationship across UAE categories (increasing risk from normoalbuminuria to macroalbuminuria) with NODAT. Tacrolimus, sirolimus and beta-blockers (HR: 1.86 [1.07-3.22], p = 0.0277) were significantly associated with NODAT even after multiple adjustments, but not diuretics, angiotensin-converting enzyme inhibitors or angiotensin-receptor blockers. Systolic arterial pressure (HR per 10 mmHg: 1.16 [1.03-1.29], p = 0.0126) and pulse pressure (HR: 1.26 [1.12-1.43], p = 0.0002) were associated with NODAT. Only pulse pressure remained significant after adjustments. Patients at highest risks had early proteinuria and pulse pressure >60 mmHg. Early low-grade proteinuria and pulse pressure (in addition to beta-blockers) constitute independent risk factors for NODAT; they may be markers of the metabolic syndrome and/or vascular damage in renal transplant recipients.
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Affiliation(s)
- M Roland
- Service de Néphrologie-Immunologie Clinique, Hôpital Bretonneau, CHRU Tours, Tours, France
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Bøg-Hansen E, Larsson CA, Gullberg B, Melander A, Boström K, Råstam L, Lindblad U. Predictors of acute myocardial infarction mortality in hypertensive patients treated in primary care: a population-based follow-up study in the Skaraborg Project. Scand J Prim Health Care 2007; 25:237-43. [PMID: 17965983 PMCID: PMC3379766 DOI: 10.1080/02813430701706253] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Abstract
OBJECTIVE To explore risk factors for acute myocardial infarction (AMI) mortality in hypertensive patients treated in primary care. DESIGN Community-based cohort study. SETTING Hypertension outpatient clinic in primary health care. SUBJECTS Patients who consecutively underwent an annual follow-up during 1992-1993 (n =894; 377 men and 517 women). METHODS All events of fatal AMI were ascertained by record linkage to the National Mortality Register to December 31, 2002. Gender-specific predictors for AMI mortality were analysed by Cox regression. MAIN OUTCOME MEASURE AMI mortality. RESULTS During a mean follow-up of 8.7 years 32 cases (8.5%) of fatal AMI were observed in men and 31 cases (6.0%) were observed in women. Most important predictors for AMI mortality in men were microalbuminuria (HR 3.8, CI 1.8-8.0) and left ventricular hypertrophy (HR 4.0, CI 1.7-9.4), whilst in women type 2 diabetes (HR 4.8, CI 2.4-9.8) was an important predictor. In hypertensive patients without diabetes male gender was associated with high AMI mortality (HR 2.7, CI 1.4-5.3), but in patients with both hypertension and type 2 diabetes the higher risk in men disappeared (HR 0.8, CI 0.4-1.7). CONCLUSION Cardiovascular disease risk factors remain strong predictors of AMI mortality in hypertensive patients but with a different pattern in the two genders. Markers of organ damage are more important predictors in men, whereas markers of impaired glucose metabolism are more important predictors in women.
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Affiliation(s)
- Erik Bøg-Hansen
- University of Lund, Department of Clinical Sciences, Malmö University Hospital, Malmö, Sweden.
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Di Gennaro C, Biggi A, Barilli AL, Fasoli E, Carra N, Novarini A, Delsignore R, Montanari A. Endothelial dysfunction and cardiovascular risk profile in long-term withdrawing alcoholics. J Hypertens 2007; 25:367-73. [PMID: 17211243 DOI: 10.1097/hjh.0b013e328010929c] [Citation(s) in RCA: 22] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
BACKGROUND Rates of cardiovascular morbidity and mortality are greater in heavy alcoholics than in either teetotallers or light-to-moderate drinkers. OBJECTIVE On the assumption that factors leading to atherosclerotic damage remain operative even after long-term alcohol withdrawal, we studied the possible mechanisms of raised cardiovascular risk in former heavy alcoholics. METHODS Forty-two apparently disease-free, normotensive alcoholics detoxified for 37.1 +/- 31.9 (SD) months, median 24, participated in the study. They were compared with 39 lifetime alcohol-abstaining control subjects, carefully matched for age, sex, body mass index, smoking and dietary habits, physical activity, lipids and fasting glucose. Endothelial function (flow-mediated dilation of brachial artery, high-resolution ultrasound technique), blood pressure, and some parameters of endothelial activation, oxidative stress, vascular inflammation and insulin sensitivity were measured. RESULTS The maximal percentage of flow-mediated dilatation was reduced in detoxified alcoholics (10.1 +/- 4.6 versus 14.9 +/- 7.4, P < 0.001) who also showed significantly higher blood pressure (systolic 127.5 +/- 12.9 versus 118.2 +/- 10.7 mmHg, P < 0.001; diastolic 79.4 +/- 7.1 versus 74.6 +/- 6.4 mmHg, P < 0.01; mean 95.4 +/- 8.2 versus 89.1 +/- 7.3 mmHg, P < 0.001), uric acid (5.0 +/- 1.1 versus 4.4 +/- 0.8 mg/dl, P < 0.05), high-sensitivity C-reactive protein (2.1 +/- 2.0 versus 1.0 +/- 0.9 mg/l, P < 0.01), endothelin-1 (0.38 +/- 0.11 versus 0.17 +/- 0.10 pg/ml, P < 0.001) and fasting insulin (10.4 +/- 4.5 versus 5.6 +/- 1.6 muU/ml, P < 0.001) with abnormal homeostasis model assessment index of insulin resistance (2.3 +/- 1.1 versus 1.2 +/- 0.4, P < 0.001). CONCLUSION Previous heavy alcoholism, in spite of long-term withdrawal, is associated with endothelial dysfunction and a wide cluster of haemodynamic, vascular and metabolic abnormalities that indicate an unfavourable cardiovascular and metabolic risk profile even in apparently disease-free former alcoholics.
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Affiliation(s)
- Cristiana Di Gennaro
- Center for Study and Treatment of Alcoholism, Dipartimento di Medicina Interna e Scienze Biomediche, University of Parma, Parma, Italy
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Bonnet F, Marre M, Halimi JM, Stengel B, Lange C, Laville M, Tichet J, Balkau B. Waist circumference and the metabolic syndrome predict the development of elevated albuminuria in non-diabetic subjects: the DESIR Study. J Hypertens 2006; 24:1157-63. [PMID: 16685216 DOI: 10.1097/01.hjh.0000226206.03560.ac] [Citation(s) in RCA: 88] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE Metabolic determinants of microalbuminuria remain poorly understood in non-diabetic individuals and particularly in women. We investigated in both sexes whether an elevated waist circumference (WC) or the presence of the metabolic syndrome (MetS) predict the development of elevated albuminuria at 6 years. DESIGN AND PATIENTS We studied 2738 subjects from the DESIR cohort without microalbuminuria or diabetes at baseline and who were followed up for 6 years. RESULTS At 6 years, 254 individuals [9.3%; 95% confidence interval (CI) 8.2-10.4%] had developed elevated albuminuria (> or = 20 mg/l), which was significantly and positively associated with WC and blood pressure, but not with fasting glucose, lipids or body mass index in either sex. In both sexes, subjects with a high WC or with MetS at baseline were more likely to develop elevated albuminuria at 6 years compared with those with a normal WC or absence of MetS. In multivariate logistic analysis, WC as a continuous variable or a WC of 94 cm or greater for men and a WC greater than 88 cm for women were predictive of the development of elevated albuminuria, after adjusting for age, hypertension, the use of angiotensin-converting enzyme inhibitors, fibrinogen and glycaemia. MetS was a risk factor for elevated albuminuria in men (odds ratio 1.87; 95% CI 1.25-2.81), with differences according to the MetS definition. CONCLUSION Abdominal adiposity is related to the development of elevated albuminuria in both sexes, suggesting that the measurement of WC may improve the identification of non-diabetic individuals at risk of developing microalbuminuria and emphasizing the interest of screening for albuminuria among those with MetS.
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Affiliation(s)
- Fabrice Bonnet
- Department of Diabetology-Endocrinology, CRNH, Hospital Edouard Herriot, INSERM U 449, Lyon, France.
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Sarafidis PA, Bakris GL. Microalbuminuria and chronic kidney disease as risk factors for cardiovascular disease. Nephrol Dial Transplant 2006; 21:2366-74. [PMID: 16782993 DOI: 10.1093/ndt/gfl309] [Citation(s) in RCA: 77] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
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De Cosmo S, Minenna A, Ludovico O, Mastroianno S, Di Giorgio A, Pirro L, Trischitta V. Increased urinary albumin excretion, insulin resistance, and related cardiovascular risk factors in patients with type 2 diabetes: evidence of a sex-specific association. Diabetes Care 2005; 28:910-5. [PMID: 15793194 DOI: 10.2337/diacare.28.4.910] [Citation(s) in RCA: 80] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
OBJECTIVE While the relevant role of insulin resistance in the pathogenesis of increased urinary albumin excretion (UAE) is well established in type 1 diabetes, its contribution in type 2 diabetes is controversial. Our aim was to investigate whether insulin resistance was associated with increased UAE in a large cohort of patients with type 2 diabetes. RESEARCH DESIGN AND METHODS A total of 363 men and 349 women, aged 61 +/- 9 years, with a disease duration of 11 +/- 9 years and HbA(1c) levels of 8.6 +/- 2.0% were included. Insulin resistance was derived from the homeostasis model assessment of insulin resistance (HOMA(IR)), and UAE was derived from the albumin-to-creatinine ratio (ACR) defined as increased if the value was > or =2.5 mg/mmol in men and > or =3.5 mg/mmol in women. ACR was correlated with HOMA(IR) (r = 0.15, P = 0.0001), independently of age, disease duration, blood pressure, HbA(1c), triglycerides, waist circumference, and smoking. RESULTS When the two sexes were investigated separately, a significant correlation between ACR and HOMA(IR) was reached in men (n = 363; r = 0.21, P = 0.0001) but not women (n = 349; r = 0.08, P = 0.14), suggesting that insulin resistance and sex may interact (P for interaction = 0.04) in determining UAE. When men were subgrouped into quartiles of HOMA(IR), those of the third and fourth quartile (i.e., the most insulin resistant) were at higher risk to have increased ACR than patients of the first quartile (third quartile: odds ratio 2.2 [95% CI 1.2-4.2], P = 0.01) (fourth quartile: 4.1 [2.2-7.9], P = 0.00002). Finally, ACR was significantly higher in men with two or more insulin resistance-related cardiovascular risk factors (i.e., abdominal obesity, dyslipidemia, and arterial hypertension) than in men with fewer than two insulin resistance-related cardiovascular risk factors (0.90 [0.2-115.1] vs. 1.56 [0.1-1367.6], respectively, P = 0.005). CONCLUSIONS In type 2 diabetic patients, increased UAE is strongly associated with insulin resistance and related cardiovascular risk factors. This association seems to be stronger in men than in women.
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Affiliation(s)
- Salvatore De Cosmo
- Unit of Endocrinology Scientific Institute Casa Sollievo della Sofferenza, 71013 San Giovanni Rotondo, Foggia, Italy.
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Lane JT. Microalbuminuria as a marker of cardiovascular and renal risk in type 2 diabetes mellitus: a temporal perspective. Am J Physiol Renal Physiol 2004; 286:F442-50. [PMID: 14761931 DOI: 10.1152/ajprenal.00247.2003] [Citation(s) in RCA: 60] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023] Open
Abstract
Microalbuminuria is a marker for diabetic nephropathy. It also signifies cardiovascular disease, as well as nephropathy, in type 2 diabetes (DM2). Microalbuminuria may precede DM2, occurring with the insulin resistance syndrome and its components, including obesity and hypertension. Other indicators of cardiovascular risk, such as markers of inflammation, are associated with microalbuminuria in populations of patients with and without diabetes. With the rising prevalence of DM2 in minority youth, especially in Native Americans, a marker for future disease risk would allow earlier prevention strategies to be tested. Before microalbuminuria can be used in a prevention strategy, more needs to be known about the mechanism(s) of the association between elevated excretion, its relationship to glucose intolerance, and its relative contribution to cardiovascular and renal disease. These questions are especially applicable as we begin to observe the long-term complications of diabetes in youth.
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Affiliation(s)
- James T Lane
- Department of Internal Medicine, University of Nebraska Medical Center, Omaha, NE 68198-3020, USA.
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Garg JP, Bakris GL. Microalbuminuria: marker of vascular dysfunction, risk factor for cardiovascular disease. Vasc Med 2002; 7:35-43. [PMID: 12083733 DOI: 10.1191/1358863x02vm412ra] [Citation(s) in RCA: 210] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Based on the data from large single and multi-center clinical trials, including the Heart Outcomes Prevention Evaluation (HOPE) study, it is clear that the presence of microalbuminuria is a signal from the kidney that cardiovascular risk is increased and that vascular responses are altered. This is exemplified by studies that have demonstrated that the compensatory vasodilation seen following relief from prolonged ischemia or infusion of vasodilators such as nitroglycerin is blunted in people with microalbuminuria. Thus, the presence of between 30 and 299 mg/day of albumin in the urine is associated with abnormal vascular responsiveness, which may be the result of more advanced atherosclerosis and not necessarily related to the presence of hypertension or renal disease. Agents known to reduce the rise in microalbuminuria or actually reduce the level of microalbuminuria, such as ACE inhibitors, angiotensin receptor blockers, HMG-CoA reductase inhibitors, beta blockers, non-dihydropyridine calcium channel blockers and diuretics, have all been shown to reduce cardiovascular mortality and in some cases preserve renal function. This article will present an overview of the data that support the assertion that a reduction in the rise of microalbuminuria is a significant consideration in the selection of agents to treat a given risk factor (cholesterol or blood pressure) to a recommended target goal. Achieving such a goal with agents that also impact microalbuminuria will provide for a more complete cardiovascular risk reduction.
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Affiliation(s)
- Jay P Garg
- Rush Presbyterian/St Luke's Medical Center, Department of Preventive Medicine, Hypertensison/Clinical Research Center, Chicago, IL 60612, USA.
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