title: Albuminuria, metabolic syndrome and the risk of mortality and cardiovascular events.
abstract: OBJECTIVE
  Increased urinary albumin-excretion is a cardiovascular risk-factor. The cardiovascular risk of the metabolic syndrome (MetS) is debated. The aim of the present prospective, population-based study of non-diabetic individuals was to examine the association between low-grade urinary albumin-excretion, MetS, and cardiovascular morbidity and all-cause mortality.
  
  
  METHODS
  5215 non-diabetic, non-proteinuric men and women participating in the Tromsø Study 1994-1995 were included. Urinary albumin-creatinine ratio (ACR) was measured in three urine samples. The participants were categorized into four groups by the presence/absence of MetS (the International Diabetes Federation definition) and ACR in the upper tertile (>or=0.75 mg/mmol).
  
  
  RESULTS
  Median follow-up time was 9.6 years for first ever myocardial infarction, 9.7 years for ischemic stroke and 12.4 years for mortality. High ACR (upper tertile)/MetS was associated with increased risk of myocardial infarction (hazard ratio (HR) 1.75; 95% confidence interval (CI): 1.30-2.37, p<0.001), stroke (HR 2.48; 95% CI: 1.66-3.71, p<0.001), and all-cause mortality (HR 1.63; 95% CI: 1.32-2.01, p<0.001) compared to reference (low ACR/no MetS). Similar associations were found for the high ACR/no MetS group. Low ACR/MetS was associated with myocardial infarction only (HR 1.82; 95% CI: 1.39-2.37, p<0.001). MetS predicted neither stroke nor mortality. Adjusted for its individual components, MetS was not associated with any end-point.
  
  
  CONCLUSIONS
  ACR>or=0.75 mg/mmol was associated with cardiovascular morbidity and all-cause mortality independently of MetS. MetS was not associated with any end-point beyond what was predicted from its components. Thus, low-grade albuminuria, but not MetS, may be used for risk stratification in non-diabetic subjects.
authors.affiliation: Department of Nephrology, University Hospital of North Norway, Tromsø, Norway. marit.solbu@unn.no
authors.forename: Marit D
authors.initials: MD
authors.lastname: Solbu
authors.forename: Jens
authors.initials: J
authors.lastname: Kronborg
authors.forename: Trond G
authors.initials: TG
authors.lastname: Jenssen
authors.forename: Inger
authors.initials: I
authors.lastname: Njølstad
authors.forename: Maja-Lisa
authors.initials: ML
authors.lastname: Løchen
authors.forename: Ellisiv B
authors.initials: EB
authors.lastname: Mathiesen
authors.forename: Tom
authors.initials: T
authors.lastname: Wilsgaard
authors.forename: Bjørn O
authors.initials: BO
authors.lastname: Eriksen
authors.forename: Ingrid
authors.initials: I
authors.lastname: Toft
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications* / Q000401:mortality / Q000652:urine; D015415:Biomarkers / Q000652:urine; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D015994:Incidence; D008297:Male; D024821:Metabolic Syndrome / Q000150:complications* / Q000401:mortality; D008875:Middle Aged; D009203:Myocardial Infarction / Q000209:etiology* / Q000401:mortality; D009664:Norway / Q000453:epidemiology; D011159:Population Surveillance; D016016:Proportional Hazards Models; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D020521:Stroke / Q000209:etiology* / Q000401:mortality; D013997:Time Factors
chemical_list: D015415:Biomarkers; D003404:Creatinine