Author + information
- Received November 25, 2009
- Revision received January 20, 2010
- Accepted January 20, 2010
- Published online June 1, 2010.
- Andrew P. DeFilippis, MD, MSc⁎,
- Holly J. Kramer, MD, MPH†,
- Ronit Katz, DPhil‡,
- Nathan D. Wong, PhD§,
- Alain G. Bertoni, MD∥,
- Jeffrey Carr, MD∥,
- Matthew J. Budoff, MD¶,
- Roger S. Blumenthal, MD⁎ and
- Khurram Nasir, MD, MPH⁎,#⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Khurram Nasir, Blalock 524 C-Division of Cardiology, Johns Hopkins University, 600 North Wolfe Street, Baltimore, Maryland 21287
Objectives This study sought to evaluate the relationship between microalbuminuria (MA) and the development and progression of atherosclerosis, as assessed by incident and progression of coronary artery calcification (CAC).
Background MA is associated with an increased risk of cardiovascular disease, but the mechanism by which MA imparts this increased risk is not known.
Methods The MESA (Multi-Ethnic Study of Atherosclerosis) study is a prospective cohort study of 6,814 self-identified White, African-American, Hispanic, or Chinese participants free of clinical cardiovascular disease at entry. Of the 6,775 individuals with available urine albumin data, we excluded 97 subjects with macroalbuminuria and 1,023 with missing follow-up CAC data. The final study population consists of 5,666 subjects.
Results At baseline, individuals with MA were more likely to have CAC >0 compared with those without MA (62% vs. 48%, p < 0.0001). During a mean follow-up of 2.4 ± 0.8 years, those with MA and no CAC at baseline were more likely to develop CAC (relative risk [RR]: 2.05, 95% confidence interval [CI]: 1.41 to 3.02, p < 0.0001) as compared with those without MA in demographic-adjusted analyses. After multivariant adjustment, the relationship was attenuated but remained statistically significant (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005). Among those with CAC at baseline, those with versus those without MA had a 15 (95% CI: 8 to 22, p < 0.0001) volume units higher median increase in CAC in demographic-adjusted analyses. After multivariant adjustment, MA remained associated with incident CAC (RR: 1.76, 95% CI: 1.19 to 2.61, p = 0.005) and with progression of CAC (median increase in CAC volume score of 9 [95% CI: 2 to 16, p = 0.009]), relative to those without MA.
Conclusions This large multiethnic, population-based study of asymptomatic individuals demonstrates an increased risk of incident CAC as well as greater CAC progression among those with MA. Further study is needed to determine the degree to which MA precedes and predicts progression of atherosclerosis and how this information can be used to reduce cardiovascular events.
- coronary artery calcium
- risk prediction
- coronary heart disease
- Multi-Ethnic Study of Atherosclerosis
This research was supported by R01 HL071739 and contracts N01-HC-95159 through N01-HC-95165 and N01-HC-95169 from the National Heart, Lung, and Blood Institute. Dr. DeFilippis is supported by a National Research Service Award (NRSA) Training Grant (T32-HL-07227). Dr. Budoff is on the speakers bureau for General Electric (<$10,000/year).
- Received November 25, 2009.
- Revision received January 20, 2010.
- Accepted January 20, 2010.
- American College of Cardiology Foundation