Short-term prognosis role of microalbuminuria in patients with ischemic heart disease

Introduction: T he link between microalbuminuria and cardiovascular risk remains poorly understood. Currently, the most likely possibility is a common pathophysiologic process, such as endothelial dysfunc-tion, chronic low-grade inflammation, or increased transvascular leakage of macromolecules in the glo-merular membrane, underlies the association between microalbuminuria and cardiovascular disease through its significant role in the onset and progression of athe-rosclerosis.
Objective: Considering its role of early, strong and independent marker of cardiovascular morbidity and mortality, our study underlines the importance of assessing the presence of microalbuminuria and, consecutively, the target organ reach – focusing on left ven-tricular hypertrophy and on intima-media thickness and the need for a more aggressive drug therapy in hypertensive patients.
Methods: This is a primary observational study con-ducted in the Cardiology Clinic in Cluj-Napoca, from January 2016 to January 2017. The study sample con-sisted of 99 patients tested for microalbuminuria. The exclusion criteria were: recent history of myocardial infarction or stroke, diabetes, heart failure NYHA IV, renal failure (glomerular filtration rate <60 mL/min), urinary infections or acute systemic infections. UAC (urinary albumin concentration) has a high sensitivity and specificity for detecting microalbuminuria. A sam-ple of 10 mL of the first morning urine („spot test”) was collected. The tests have been carried on a standard-re-agent laboratory analyser. The values <20 mg/dL were considered normal, values ranging between 20-200 mg/dL – microalbuminuria, over 200 mg/dL – clinical macroalbuminuria. Data collected from patients’ me-dical records have been processed using the SPPS 20.0 statistics software
Results: Patients were divided into 3 groups: those who suffer from IHD (40.40%), from HTA (31.31%), and from both HTA and IHD (28.28%). The analysis was further carried on patients with IHD, the main interest group. Pursuant the bivariate analysis, the following correlations have been identified: microalbuminuria is positively correlated with the PW (posterior wall) thickness, the interventricular septum (IVS) is positi-vely correlated with PW.Linear regressions showed that an increase of mA by one unit, the PW of the LV in-creases by 0.017. There is a correlation between the left ventricular hypertrophy (LVH) (expressed based on the PW thickness) and microalbuminuria. mA is asso-ciated with carotid intima-media index >0.9 (IMT), an increase of mA by one unit determines the IMT in the bilateral common carotid artery to increase by 0.003. The existence of a common pathophysiological mecha-nism: endothelial dysfunction and chronic inflamma-tion, would explain the association between mA and vascular affection (with impact on carotid atheromato-sis). Link between stroke and microalbuminuria prove a statistically significant correlation. Values of microal-buminuria >20 mg/dL are prognosis factors for ische-mic or hemorrhagic stroke; the higher the mA values, the higher risk for developing a haemorrhagic stroke Conclusions: Results show statistically significant link between mA and LVH, supporting the idea that mA and LVH are independent predictive factors for coronary disease. The IMT measured in the carotid arte-ries has been linked to mA. This tends to confirm the role of mA as indicator of subclinical atherosclerosis, per se. In our study, patients presented an important CV risk factors aggregation. All findings have shown that mA predicts cardiovascular events, and data col-lected so far suggest that pathological changes causing microalbuminuria and disorders leading to early athe-rosclerosis are the same. Patients with increased albu-minuria levels should be examined in terms of target organ impairment in order to prevent underdiagnosis and insufficient treatment.

ISSN – online: 2734 – 6382
ISSN-L 1220-658X
ISSN – print: 1220-658X
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CODE: 379
CME Credits: 10 (Romanian College of Physicians)
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