Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease
Patients with chronic kidney disease are at increased risk for cardiovascular morbidity and mortality. We assessed the association between albuminuria and the risks for death and cardiovascular events among patients with stable coronary disease. We studied patients enrolled in the Prevention of Even...
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| Veröffentlicht in: | Circulation (New York, N.Y.) N.Y.), 2007-12, Vol.116 (23), p.2687-2693 |
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| creator | SOLOMON, Scott D LIN, Julie ROULEAU, Jean BRAUNWALD, Eugene PFEFFER, Marc A SOLOMON, Caren G JABLONSKI, Kathleen A MURGUIA RICE, Madeline STEFFES, Michael DOMANSKI, Michael HSIA, Judith GERSH, Bernard J ARNOLD, J. Malcolm O |
| description | Patients with chronic kidney disease are at increased risk for cardiovascular morbidity and mortality. We assessed the association between albuminuria and the risks for death and cardiovascular events among patients with stable coronary disease.
We studied patients enrolled in the Prevention of Events with an ACE inhibitor (PEACE) trial, in which patients with chronic stable coronary disease and preserved systolic function were randomized to trandolapril or placebo and followed up for a median of 4.8 years. The urinary albumin to creatinine ratio (ACR) assessed in a core laboratory in 2977 patients at baseline and in 1339 patients at follow-up (mean 34 months) was related to estimated glomerular filtration rate and outcomes. The majority of patients (73%) had a baseline ACR within the normal range ( |
| doi_str_mv | 10.1161/CIRCULATIONAHA.107.723270 |
| format | Article |
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We studied patients enrolled in the Prevention of Events with an ACE inhibitor (PEACE) trial, in which patients with chronic stable coronary disease and preserved systolic function were randomized to trandolapril or placebo and followed up for a median of 4.8 years. The urinary albumin to creatinine ratio (ACR) assessed in a core laboratory in 2977 patients at baseline and in 1339 patients at follow-up (mean 34 months) was related to estimated glomerular filtration rate and outcomes. The majority of patients (73%) had a baseline ACR within the normal range (<17 mug/mg for men and <25 mug/mg for women). Independent of the estimated glomerular filtration rate and other baseline covariates, a higher ACR, even within the normal range, was associated with increased risks for all-cause mortality (P<0.001) and cardiovascular death (P=0.01). The effect of trandolapril therapy on outcomes was not modified significantly by the level of albuminuria. Nevertheless, trandolapril therapy was associated with a significantly lower mean follow-up ACR (12.5 versus 14.6 mug/mg, P=0.0002), after adjustment for baseline ACR, time between collections, and other covariates. An increase in ACR over time was associated with increased risk of cardiovascular death (hazard ratio per log ACR 1.74, 95% CI 1.08 to 2.82).
Albuminuria, even in low levels within the normal range, is an independent predictor of cardiovascular and all-cause mortality.</description><identifier>ISSN: 0009-7322</identifier><identifier>EISSN: 1524-4539</identifier><identifier>DOI: 10.1161/CIRCULATIONAHA.107.723270</identifier><identifier>PMID: 18025537</identifier><identifier>CODEN: CIRCAZ</identifier><language>eng</language><publisher>Hagerstown, MD: Lippincott Williams & Wilkins</publisher><subject>Aged ; Albuminuria - complications ; Albuminuria - drug therapy ; Albuminuria - mortality ; Albuminuria - physiopathology ; Albuminuria - urine ; Angiotensin-Converting Enzyme Inhibitors - administration & dosage ; Atherosclerosis (general aspects, experimental research) ; Biological and medical sciences ; Blood and lymphatic vessels ; Cardiology. Vascular system ; Chronic Disease ; Coronary Disease - complications ; Coronary Disease - drug therapy ; Coronary Disease - mortality ; Coronary Disease - physiopathology ; Coronary Disease - urine ; Coronary heart disease ; Creatinine - urine ; Death ; Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous ; Female ; Follow-Up Studies ; Glomerular Filtration Rate - drug effects ; Heart ; Humans ; Indoles - administration & dosage ; Kidney Diseases - complications ; Kidney Diseases - drug therapy ; Kidney Diseases - mortality ; Kidney Diseases - physiopathology ; Kidney Diseases - urine ; Male ; Medical sciences ; Middle Aged ; Predictive Value of Tests ; Randomized Controlled Trials as Topic ; Risk Factors ; Survival Rate</subject><ispartof>Circulation (New York, N.Y.), 2007-12, Vol.116 (23), p.2687-2693</ispartof><rights>2008 INIST-CNRS</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c439t-5dd0e023a25e2356fe3dd01cd6a12b60e4b78ed8e34fe929247c30871bfdaafd3</citedby><cites>FETCH-LOGICAL-c439t-5dd0e023a25e2356fe3dd01cd6a12b60e4b78ed8e34fe929247c30871bfdaafd3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,3674,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=19912720$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/18025537$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>SOLOMON, Scott D</creatorcontrib><creatorcontrib>LIN, Julie</creatorcontrib><creatorcontrib>ROULEAU, Jean</creatorcontrib><creatorcontrib>BRAUNWALD, Eugene</creatorcontrib><creatorcontrib>PFEFFER, Marc A</creatorcontrib><creatorcontrib>SOLOMON, Caren G</creatorcontrib><creatorcontrib>JABLONSKI, Kathleen A</creatorcontrib><creatorcontrib>MURGUIA RICE, Madeline</creatorcontrib><creatorcontrib>STEFFES, Michael</creatorcontrib><creatorcontrib>DOMANSKI, Michael</creatorcontrib><creatorcontrib>HSIA, Judith</creatorcontrib><creatorcontrib>GERSH, Bernard J</creatorcontrib><creatorcontrib>ARNOLD, J. Malcolm O</creatorcontrib><creatorcontrib>Prevention of Events With ACE Inhibition (PEACE) Investigators</creatorcontrib><title>Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease</title><title>Circulation (New York, N.Y.)</title><addtitle>Circulation</addtitle><description>Patients with chronic kidney disease are at increased risk for cardiovascular morbidity and mortality. We assessed the association between albuminuria and the risks for death and cardiovascular events among patients with stable coronary disease.
We studied patients enrolled in the Prevention of Events with an ACE inhibitor (PEACE) trial, in which patients with chronic stable coronary disease and preserved systolic function were randomized to trandolapril or placebo and followed up for a median of 4.8 years. The urinary albumin to creatinine ratio (ACR) assessed in a core laboratory in 2977 patients at baseline and in 1339 patients at follow-up (mean 34 months) was related to estimated glomerular filtration rate and outcomes. The majority of patients (73%) had a baseline ACR within the normal range (<17 mug/mg for men and <25 mug/mg for women). Independent of the estimated glomerular filtration rate and other baseline covariates, a higher ACR, even within the normal range, was associated with increased risks for all-cause mortality (P<0.001) and cardiovascular death (P=0.01). The effect of trandolapril therapy on outcomes was not modified significantly by the level of albuminuria. Nevertheless, trandolapril therapy was associated with a significantly lower mean follow-up ACR (12.5 versus 14.6 mug/mg, P=0.0002), after adjustment for baseline ACR, time between collections, and other covariates. An increase in ACR over time was associated with increased risk of cardiovascular death (hazard ratio per log ACR 1.74, 95% CI 1.08 to 2.82).
Albuminuria, even in low levels within the normal range, is an independent predictor of cardiovascular and all-cause mortality.</description><subject>Aged</subject><subject>Albuminuria - complications</subject><subject>Albuminuria - drug therapy</subject><subject>Albuminuria - mortality</subject><subject>Albuminuria - physiopathology</subject><subject>Albuminuria - urine</subject><subject>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</subject><subject>Atherosclerosis (general aspects, experimental research)</subject><subject>Biological and medical sciences</subject><subject>Blood and lymphatic vessels</subject><subject>Cardiology. Vascular system</subject><subject>Chronic Disease</subject><subject>Coronary Disease - complications</subject><subject>Coronary Disease - drug therapy</subject><subject>Coronary Disease - mortality</subject><subject>Coronary Disease - physiopathology</subject><subject>Coronary Disease - urine</subject><subject>Coronary heart disease</subject><subject>Creatinine - urine</subject><subject>Death</subject><subject>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</subject><subject>Female</subject><subject>Follow-Up Studies</subject><subject>Glomerular Filtration Rate - drug effects</subject><subject>Heart</subject><subject>Humans</subject><subject>Indoles - administration & dosage</subject><subject>Kidney Diseases - complications</subject><subject>Kidney Diseases - drug therapy</subject><subject>Kidney Diseases - mortality</subject><subject>Kidney Diseases - physiopathology</subject><subject>Kidney Diseases - urine</subject><subject>Male</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Predictive Value of Tests</subject><subject>Randomized Controlled Trials as Topic</subject><subject>Risk Factors</subject><subject>Survival Rate</subject><issn>0009-7322</issn><issn>1524-4539</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2007</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNpVkE1Lw0AQhhdRbK3-BVkPekvdjySbPYb40UKxUls8hk0yi6vpRncTwX_vSgvF0zDD884MD0JXlEwpTeltMV8Vm0W-ni-f8lk-pURMBeNMkCM0pgmLozjh8hiNCSEyEpyxETrz_j20KRfJKRrRjLAk4WKMyrnV7QC2BtxpnLfVsDV2cEbhzuJCucZ038rXQ6scXhn_gY3Fz6o3YHuPX03_hl96VbWAi851VrkfnLseQrkzHpSHc3SiVevhYl8naPNwvy5m0WL5OC_yRVTHXPZR0jQECOOKJcB4kmrgYULrJlWUVSmBuBIZNBnwWINkksWi5iQTtNKNUrrhE3Sz2_vpuq8BfF9uja-hbZWFbvBlKgkTWcwDKHdg7TrvHejy05lteLykpPyzW_63G8ai3NkN2cv9kaHaQnNI7nUG4HoPBGeq1U7Z2vgDJyVlghH-C_MshXo</recordid><startdate>20071204</startdate><enddate>20071204</enddate><creator>SOLOMON, Scott D</creator><creator>LIN, Julie</creator><creator>ROULEAU, Jean</creator><creator>BRAUNWALD, Eugene</creator><creator>PFEFFER, Marc A</creator><creator>SOLOMON, Caren G</creator><creator>JABLONSKI, Kathleen A</creator><creator>MURGUIA RICE, Madeline</creator><creator>STEFFES, Michael</creator><creator>DOMANSKI, Michael</creator><creator>HSIA, Judith</creator><creator>GERSH, Bernard J</creator><creator>ARNOLD, J. Malcolm O</creator><general>Lippincott Williams & Wilkins</general><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>20071204</creationdate><title>Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease</title><author>SOLOMON, Scott D ; LIN, Julie ; ROULEAU, Jean ; BRAUNWALD, Eugene ; PFEFFER, Marc A ; SOLOMON, Caren G ; JABLONSKI, Kathleen A ; MURGUIA RICE, Madeline ; STEFFES, Michael ; DOMANSKI, Michael ; HSIA, Judith ; GERSH, Bernard J ; ARNOLD, J. Malcolm O</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c439t-5dd0e023a25e2356fe3dd01cd6a12b60e4b78ed8e34fe929247c30871bfdaafd3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2007</creationdate><topic>Aged</topic><topic>Albuminuria - complications</topic><topic>Albuminuria - drug therapy</topic><topic>Albuminuria - mortality</topic><topic>Albuminuria - physiopathology</topic><topic>Albuminuria - urine</topic><topic>Angiotensin-Converting Enzyme Inhibitors - administration & dosage</topic><topic>Atherosclerosis (general aspects, experimental research)</topic><topic>Biological and medical sciences</topic><topic>Blood and lymphatic vessels</topic><topic>Cardiology. Vascular system</topic><topic>Chronic Disease</topic><topic>Coronary Disease - complications</topic><topic>Coronary Disease - drug therapy</topic><topic>Coronary Disease - mortality</topic><topic>Coronary Disease - physiopathology</topic><topic>Coronary Disease - urine</topic><topic>Coronary heart disease</topic><topic>Creatinine - urine</topic><topic>Death</topic><topic>Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous</topic><topic>Female</topic><topic>Follow-Up Studies</topic><topic>Glomerular Filtration Rate - drug effects</topic><topic>Heart</topic><topic>Humans</topic><topic>Indoles - administration & dosage</topic><topic>Kidney Diseases - complications</topic><topic>Kidney Diseases - drug therapy</topic><topic>Kidney Diseases - mortality</topic><topic>Kidney Diseases - physiopathology</topic><topic>Kidney Diseases - urine</topic><topic>Male</topic><topic>Medical sciences</topic><topic>Middle Aged</topic><topic>Predictive Value of Tests</topic><topic>Randomized Controlled Trials as Topic</topic><topic>Risk Factors</topic><topic>Survival Rate</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>SOLOMON, Scott D</creatorcontrib><creatorcontrib>LIN, Julie</creatorcontrib><creatorcontrib>ROULEAU, Jean</creatorcontrib><creatorcontrib>BRAUNWALD, Eugene</creatorcontrib><creatorcontrib>PFEFFER, Marc A</creatorcontrib><creatorcontrib>SOLOMON, Caren G</creatorcontrib><creatorcontrib>JABLONSKI, Kathleen A</creatorcontrib><creatorcontrib>MURGUIA RICE, Madeline</creatorcontrib><creatorcontrib>STEFFES, Michael</creatorcontrib><creatorcontrib>DOMANSKI, Michael</creatorcontrib><creatorcontrib>HSIA, Judith</creatorcontrib><creatorcontrib>GERSH, Bernard J</creatorcontrib><creatorcontrib>ARNOLD, J. Malcolm O</creatorcontrib><creatorcontrib>Prevention of Events With ACE Inhibition (PEACE) Investigators</creatorcontrib><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>Circulation (New York, N.Y.)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>SOLOMON, Scott D</au><au>LIN, Julie</au><au>ROULEAU, Jean</au><au>BRAUNWALD, Eugene</au><au>PFEFFER, Marc A</au><au>SOLOMON, Caren G</au><au>JABLONSKI, Kathleen A</au><au>MURGUIA RICE, Madeline</au><au>STEFFES, Michael</au><au>DOMANSKI, Michael</au><au>HSIA, Judith</au><au>GERSH, Bernard J</au><au>ARNOLD, J. Malcolm O</au><aucorp>Prevention of Events With ACE Inhibition (PEACE) Investigators</aucorp><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease</atitle><jtitle>Circulation (New York, N.Y.)</jtitle><addtitle>Circulation</addtitle><date>2007-12-04</date><risdate>2007</risdate><volume>116</volume><issue>23</issue><spage>2687</spage><epage>2693</epage><pages>2687-2693</pages><issn>0009-7322</issn><eissn>1524-4539</eissn><coden>CIRCAZ</coden><abstract>Patients with chronic kidney disease are at increased risk for cardiovascular morbidity and mortality. We assessed the association between albuminuria and the risks for death and cardiovascular events among patients with stable coronary disease.
We studied patients enrolled in the Prevention of Events with an ACE inhibitor (PEACE) trial, in which patients with chronic stable coronary disease and preserved systolic function were randomized to trandolapril or placebo and followed up for a median of 4.8 years. The urinary albumin to creatinine ratio (ACR) assessed in a core laboratory in 2977 patients at baseline and in 1339 patients at follow-up (mean 34 months) was related to estimated glomerular filtration rate and outcomes. The majority of patients (73%) had a baseline ACR within the normal range (<17 mug/mg for men and <25 mug/mg for women). Independent of the estimated glomerular filtration rate and other baseline covariates, a higher ACR, even within the normal range, was associated with increased risks for all-cause mortality (P<0.001) and cardiovascular death (P=0.01). The effect of trandolapril therapy on outcomes was not modified significantly by the level of albuminuria. Nevertheless, trandolapril therapy was associated with a significantly lower mean follow-up ACR (12.5 versus 14.6 mug/mg, P=0.0002), after adjustment for baseline ACR, time between collections, and other covariates. An increase in ACR over time was associated with increased risk of cardiovascular death (hazard ratio per log ACR 1.74, 95% CI 1.08 to 2.82).
Albuminuria, even in low levels within the normal range, is an independent predictor of cardiovascular and all-cause mortality.</abstract><cop>Hagerstown, MD</cop><pub>Lippincott Williams & Wilkins</pub><pmid>18025537</pmid><doi>10.1161/CIRCULATIONAHA.107.723270</doi><tpages>7</tpages><oa>free_for_read</oa></addata></record> |
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| ispartof | Circulation (New York, N.Y.), 2007-12, Vol.116 (23), p.2687-2693 |
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| source | MEDLINE; American Heart Association Journals; Elektronische Zeitschriftenbibliothek - Frei zugängliche E-Journals; Journals@Ovid Complete |
| subjects | Aged Albuminuria - complications Albuminuria - drug therapy Albuminuria - mortality Albuminuria - physiopathology Albuminuria - urine Angiotensin-Converting Enzyme Inhibitors - administration & dosage Atherosclerosis (general aspects, experimental research) Biological and medical sciences Blood and lymphatic vessels Cardiology. Vascular system Chronic Disease Coronary Disease - complications Coronary Disease - drug therapy Coronary Disease - mortality Coronary Disease - physiopathology Coronary Disease - urine Coronary heart disease Creatinine - urine Death Diseases of the peripheral vessels. Diseases of the vena cava. Miscellaneous Female Follow-Up Studies Glomerular Filtration Rate - drug effects Heart Humans Indoles - administration & dosage Kidney Diseases - complications Kidney Diseases - drug therapy Kidney Diseases - mortality Kidney Diseases - physiopathology Kidney Diseases - urine Male Medical sciences Middle Aged Predictive Value of Tests Randomized Controlled Trials as Topic Risk Factors Survival Rate |
| title | Influence of Albuminuria on Cardiovascular Risk in Patients With Stable Coronary Artery Disease |
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