A structured review of the relationship between microalbuminuria and cardiovascular events in patients with diabetes mellitus and hypertension.
OBJECTIVE
To quantify the relative risk of cardiovascular events associated with microalbuminuria in patients with both diabetes mellitus and hypertension.


METHODS
A structured literature search from January 1990-December 2002 using MEDLINE, IPA, and CINAHL.


RESULTS
We identified original studies that reported the presence or absence of microalbuminuria and estimates of risk associated with cardiovascular events in patients with both diabetes and hypertension. Abstracted information consisted of study design, patient demographics and risk factors, treatment regimens, and outcome variables. Point estimates and confidence intervals for relative risk were calculated from available data. Of 651 citations identified and reviewed based on title and abstract, 72 were selected for full review. Seven met the inclusion criteria. Because of lack of homogeneity among studies, the results were not conducive to pooling. Cardiovascular end points associated with the presence of microalbuminuria in these studies were all-cause mortality, cardiovascular mortality, and composite cardiovascular morbidity. The relative risk of cardiovascular end points associated with the presence of microalbuminuria ranged from 1.6 (95% confidence interval [CI] 1.2-2.2) to 7.9 (95% CI 2.5-25.3).


CONCLUSIONS
From the limited information available, the risk of cardiovascular events and mortality is estimated to be 2-8 times higher when microalbuminuria is present in patients with diabetes and hypertension. Point estimates in relative risk of cardiovascular morbidity and mortality in patients with diabetes and hypertension were generally higher compared with studies estimating risk in those with only diabetes. Studies that examine the relationship between microalbuminuria (scaled as a continuous or ordinal variable) and cardiovascular events are necessary to clarify potential benefits of pharmacotherapies that reduce levels of urinary albumin.
Park
Hayley Y
HY
Center for Pharmacoeconomics Research, Department of Pharmacy Practice, University of Illinois at Chicago, USA.
Schumock
Glen T
GT
Pickard
A Simon
AS
Akhras
Kasem
K
D000419:Albuminuria / Q000150:complications*; D015415:Biomarkers / Q000652:urine; D002986:Clinical Trials as Topic; D048909:Diabetes Complications; D003920:Diabetes Mellitus / Q000401:mortality; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality / Q000652:urine; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality / Q000652:urine; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality / Q000652:urine
D015415:Biomarkers