title: Determining the optimal cut-off value of the urinary albumin-to-creatinine ratio to detect atherosclerotic vascular diseases.
abstract: BACKGROUND
  We examined whether low-grade albuminuria, below the conventional cut-off value for microalbuminuria, was associated with atherosclerotic vascular diseases in 8897 community-dwelling Koreans aged ≥50 years.
  
  
  METHODS
  The urinary albumin-to-creatinine ratio (UACR) was calculated using random spot urine. Common carotid artery (CCA) intimamedia thickness (IMT) and CCA internal diameter were measured using high-resolution B-mode ultrasonography, and carotid plaque was evaluated. Brachial-ankle pulse wave velocity (BaPWV) and the ankle-brachial index (ABI) were examined, and peripheral arterial disease was defined as ABI <0.9.
  
  
  RESULTS
  Youden's indices, predicting abnormal atherosclerotic conditions, were greatest at a UACR cut-off value of ∼15 mg/g, below the threshold conventionally used to define microalbuminuria. Compared with low normoalbuminuria (UACR <15.0 mg/g), CCA IMT, CCA diameter, and BaPWV were significantly greater in individuals with high normoalbuminuria (UACR 15.0-29.9 mg/g), who also had a significantly higher risk of carotid plaque than did those with low normoalbuminuria.
  
  
  CONCLUSIONS
  Subclinical atherosclerotic vascular diseases developed at lower UACRs, below the conventional classification of microalbuminuria. Further longitudinal studies are needed to investigate the relationship between microalbuminuria and the development of subclinical atherosclerosis.
authors.affiliation: Department of Preventive Medicine & Institute of Wonkwang Medical Science, Wonkwang University College of Medicine, Iksan, Jeonbuk, South Korea.
authors.forename: Young-Hoon
authors.initials: YH
authors.lastname: Lee
authors.forename: Sun-Seog
authors.initials: SS
authors.lastname: Kweon
authors.forename: Jin-Su
authors.initials: JS
authors.lastname: Choi
authors.forename: Jung-Ae
authors.initials: JA
authors.lastname: Rhee
authors.forename: Hae-Sung
authors.initials: HS
authors.lastname: Nam
authors.forename: Seul-Ki
authors.initials: SK
authors.lastname: Jeong
authors.forename: Kyeong-Soo
authors.initials: KS
authors.lastname: Park
authors.forename: Hye-Yeon
authors.initials: HY
authors.lastname: Kim
authors.forename: So-Yeon
authors.initials: SY
authors.lastname: Ryu
authors.forename: Seong-Woo
authors.initials: SW
authors.lastname: Choi
authors.forename: Bok-Hee
authors.initials: BH
authors.lastname: Kim
authors.forename: Min-Ho
authors.initials: MH
authors.lastname: Shin
mesh_terms: D000368:Aged; D000418:Albumins / Q000378:metabolism*; D000419:Albuminuria / Q000145:classification* / Q000150:complications / Q000652:urine*; D055109:Ankle Brachial Index; D050197:Atherosclerosis / Q000175:diagnosis* / Q000453:epidemiology / Q000503:physiopathology; D002339:Carotid Arteries / Q000000981:diagnostic imaging / Q000503:physiopathology; D059168:Carotid Intima-Media Thickness; D003404:Creatinine / Q000652:urine*; D005260:Female; D006306:Health Surveys; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D063177:Pulse Wave Analysis; D012015:Reference Standards; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors
chemical_list: D000418:Albumins; D003404:Creatinine