title: Statin use and the presence of microalbuminuria. Results from the ERICABEL trial: a non-interventional epidemiological cohort study.
abstract: BACKGROUND
  Microalbuminuria (MAU) is considered as a predictor or marker of cardiovascular and renal events. Statins are widely prescribed to reduce cardiovascular risk and to slow down progression of kidney disease. But statins may also generate tubular MAU. The current observational study evaluated the impact of statin use on the interpretation of MAU as a predictor or marker of cardiovascular or renal disease.
  
  
  RESULTS
  We used cross-sectional data of ERICABEL, a cohort with 1,076 hypertensive patients. MAU was defined as albuminuria ≥20 mg/l. A propensity score was created to correct for "bias by indication" to receive a statin. As expected, subjects using statins vs. no statins had more cardiovascular risk factors, pointing to bias by indication. Statin users were more likely to have MAU (OR: 2.01, 95%CI: 1.34-3.01). The association between statin use and MAU remained significant after adjusting for the propensity to receive a statin based on cardiovascular risk factors (OR: 1.82, 95%CI: 1.14-2.91). Next to statin use, only diabetes (OR: 1.92, 95%CI: 1.00-3.66) and smoking (OR: 1.49, 95%CI: 0.99-2.26) were associated with MAU.
  
  
  CONCLUSIONS
  Use of statins is independently associated with MAU, even after adjusting for bias by indication to receive a statin. In the hypothesis that this MAU is of tubular origin, statin use can result in incorrect labeling of subjects as having a predictor or marker of cardiovascular or renal risk. In addition, statin use affected the association of established cardiovascular risk factors with MAU, blurring the interpretation of multivariable analyses.
authors.affiliation: Renal Division, Department of Internal Medicine, University Hospital Ghent, Ghent, Belgium. Arjan.vandertol@ugent.be
authors.forename: Arjan
authors.initials: A
authors.lastname: van der Tol
authors.forename: Wim
authors.initials: W
authors.lastname: Van Biesen
authors.forename: Steven
authors.initials: S
authors.lastname: Van Laecke
authors.forename: Kris
authors.initials: K
authors.lastname: Bogaerts
authors.forename: Koen
authors.initials: K
authors.lastname: De Lombaert
authors.forename: Hans
authors.initials: H
authors.lastname: Warrinnier
authors.forename: Raymond
authors.initials: R
authors.lastname: Vanholder
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000139:chemically induced* / Q000453:epidemiology; D002318:Cardiovascular Diseases / Q000175:diagnosis; D015331:Cohort Studies; D003430:Cross-Sectional Studies; D003951:Diagnostic Errors; D006801:Humans; D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors / Q000009:adverse effects* / Q000627:therapeutic use; D007674:Kidney Diseases; D008875:Middle Aged
chemical_list: D019161:Hydroxymethylglutaryl-CoA Reductase Inhibitors