Microalbuminuria and endothelial dysfunction: emerging targets for primary prevention of end-organ damage.
A minor increase in urinary albumin excretion (microalbuminuria) is known to predict adverse renal and cardiovascular events in diabetic and hypertensive patients. Recent intriguing findings show that microalbuminuria is an early and sensitive marker of future cardiovascular events even in healthy subjects. The mechanisms linking microalbuminuria with end-organ damage have not been fully explained yet; however, generalized endothelial dysfunction might play an important role. Prevailing experimental and clinical data suggest that generalized endothelial dysfunction, frequently characterized by decreased nitric oxide bioavailability, actually precedes the development of microalbuminuria. This review summarizes the current knowledge about the intricate relationship between microalbuminuria and endothelial dysfunction. On the basis of the current evidence, we propose that microalbuminuria and endothelial dysfunction are an emerging target for primary prevention strategies in cardiovascular disease. In near future, dietary components improving nitric oxide bioavailability, such as cocoa-derived flavanols may play important role in these preventive strategies.
Ochodnicky
Peter
P
Department of Clinical Pharmacology, University Medical Center Groningen and Groningen Institute for Drug Exploration (GUIDE), University of Groningen, the Netherlands. p.ochodnicky@med.umcg.nl
Henning
Robert H
RH
van Dokkum
Richard P E
RP
de Zeeuw
Dick
D
D000419:Albuminuria / Q000150:complications / Q000188:drug therapy; D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors / Q000627:therapeutic use; D000818:Animals; D015415:Biomarkers / Q000032:analysis; D002199:Capillary Permeability; D002318:Cardiovascular Diseases / Q000517:prevention & control*; D015815:Cell Adhesion Molecules / Q000502:physiology; D004032:Diet; D004730:Endothelium, Vascular / Q000503:physiopathology*; D005419:Flavonoids / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000517:prevention & control*; D011322:Primary Prevention / Q000379:methods; D011379:Prognosis; D012084:Renin-Angiotensin System / Q000187:drug effects; D014664:Vasodilation; D014841:von Willebrand Factor / Q000032:analysis
D057911:Angiotensin Receptor Antagonists; D000806:Angiotensin-Converting Enzyme Inhibitors; D015415:Biomarkers; D015815:Cell Adhesion Molecules; D005419:Flavonoids; D014841:von Willebrand Factor