Association between coronary artery calcification progression and microalbuminuria: the MESA study.
OBJECTIVE
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.
DeFilippis
Andrew P
AP
Division of Cardiology, The Johns Hopkins Ciccarone Center for the Prevention of Heart Disease, Johns Hopkins University, Baltimore, Maryland, USA.
Kramer
Holly J
HJ
Katz
Ronit
R
Wong
Nathan D
ND
Bertoni
Alain G
AG
Carr
Jeffrey
J
Budoff
Matthew J
MJ
Blumenthal
Roger S
RS
Nasir
Khurram
K
D001741:Black or African American / Q000706:statistics & numerical data; D000368:Aged; D000419:Albuminuria / Q000175:diagnosis / Q000453:epidemiology* / Q000208:ethnology; D001213:Asian / Q000706:statistics & numerical data; D015415:Biomarkers / Q000652:urine; D002114:Calcinosis / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D016009:Chi-Square Distribution; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000208:ethnology; D003404:Creatinine / Q000652:urine; D018450:Disease Progression; D005260:Female; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D009391:Nephelometry and Turbidimetry; D016017:Odds Ratio; D011446:Prospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D014057:Tomography, X-Ray Computed; D014481:United States / Q000453:epidemiology; D044465:White People / Q000706:statistics & numerical data
D015415:Biomarkers; D003404:Creatinine