title: Very low levels of microalbuminuria are associated with increased risk of coronary heart disease and death independently of renal function, hypertension, and diabetes.
abstract: BACKGROUND
  The aim of this study was to assess the level of urinary albumin excretion (microalbuminuria), which is associated with increased risk of coronary heart disease and death, in the population. Microalbuminuria has been suggested as an atherosclerotic risk factor. However, the lower cutoff level of urinary albumin excretion is unknown. It is also unknown whether impaired renal function confounds the association.
  
  
  RESULTS
  In the Third Copenhagen City Heart Study in 1992 to 1994, 2762 men and women 30 to 70 years of age underwent a detailed cardiovascular investigation program, including a timed overnight urine sample. The participants were then followed up prospectively by registers until 1999 with respect to coronary heart disease and until 2001 with respect to death. During follow-up, 109 incident cases of coronary heart disease and 276 deaths were traced. A urinary albumin excretion above the upper quartile, ie, 4.8 microg/min, was associated with increased risk of coronary heart disease (RR, 2.0; 95% CI, 1.4 to 3.0; P<0.001) and death (RR, 1.9; 95% CI, 1.5 to 2.4; P<0.001) independently of age, sex, renal creatinine clearance, diabetes mellitus, hypertension, and plasma lipids. Lower levels of urinary albumin excretion were not associated with increased risk.
  
  
  CONCLUSIONS
  Microalbuminuria, defined as urinary albumin excretion >4.8 microg/min (corresponding to approximately 6.4 microg/min during daytime), is a strong and independent determinant of coronary heart disease and death. Our suggestion is to redefine microalbuminuria accordingly and perform intervention studies.
authors.affiliation: Copenhagen City Heart Study, Epidemiological Research Unit, Bispebjerg University Hospital, Copenhagen, Denmark.
authors.forename: Klaus
authors.initials: K
authors.lastname: Klausen
authors.forename: Knut
authors.initials: K
authors.lastname: Borch-Johnsen
authors.forename: Bo
authors.initials: B
authors.lastname: Feldt-Rasmussen
authors.forename: Gorm
authors.initials: G
authors.lastname: Jensen
authors.forename: Peter
authors.initials: P
authors.lastname: Clausen
authors.forename: Henrik
authors.initials: H
authors.lastname: Scharling
authors.forename: Merete
authors.initials: M
authors.lastname: Appleyard
authors.forename: Jan Skov
authors.initials: JS
authors.lastname: Jensen
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000175:diagnosis / Q000401:mortality*; D003327:Coronary Disease / Q000453:epidemiology* / Q000209:etiology; D003920:Diabetes Mellitus / Q000175:diagnosis; D005260:Female; D005500:Follow-Up Studies; D005919:Glomerular Filtration Rate; D006801:Humans; D006973:Hypertension / Q000175:diagnosis; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012307:Risk Factors