title: Low-grade albuminuria is associated with carotid atherosclerosis in normotensive and euglycemic Chinese middle-aged and elderly adults: the Shanghai Changfeng Study.
abstract: BACKGROUND
  Microalbuminuria is associated with cardiovascular disease (CVD). We investigated whether low-grade albuminuria (LGA) is independently associated with the carotid intima-media thickness (CIMT) and carotid plaques in normotensive and euglycemic Chinese middle-aged and elderly adults.
  
  
  METHODS
  A total of 1341 normotensive and euglycemic participants (489 males and 852 females; mean age, 57.7 years) with normal urinary albumin-to-creatinine ratios (UACRs) (<30 μg/mg) were enrolled from the Changfeng Study. A standard interview, anthropometric measurements and laboratory analyzes were performed for each participant. Bilateral CIMTs were measured using ultrasonography, and the presence of carotid plaques was assessed. The urinary albumin excretion rate was measured using an early morning urine sample to determine the UACR.
  
  
  RESULTS
  The median UACRs were 4.2 (interquartile range, 2.9-6.0) μg/mg and 5.6 (interquartile range, 4.0-8.2) μg/mg for male and female subjects, respectively. Compared with subjects with UACRs in the first and second tertiles, subjects of both genders with UACRs in the third tertile had greater CIMTs. After adjusting for conventional CVD risk factors and the glomerular filtration rate (GFR), male and female participants with UACRs in the third tertile for each gender had a 1.696-fold and 1.911-fold increased risk, respectively, of carotid plaques relative to those in the lowest tertiles. The logUACR was positively associated with the CIMT (β = 0.068 in males, P = 0.001; and β = 0.034 in females, P = 0.012) after adjusting for conventional CVD risk factors and the GFR. The multiple logistic regression analysis showed that a 1-unit increase in the logUACR corresponded to an odds ratio (OR) of having a carotid plaque that was 1.875 (95% confidence interval (CI) 1.103-3.538; P = 0.022) and 2.389 (95% CI 1.244-4.391; P = 0.01) for male and female subjects, respectively, after adjusting for all potential confounders.
  
  
  CONCLUSIONS
  These results suggest that the UACR is independently associated with carotid atherosclerosis in normotensive and euglycemic Chinese individuals and that even when well below the current microalbuminuria threshold, LGA contributes to the risk of atherosclerosis.
authors: Department of Endocrinology and Metabolism, Zhong Shan Hospital, Fudan University, No 180 Fenglin Road, Shanghai 200032, China.
authors: Hui
authors: H
authors: Ma
authors: Huandong
authors: H
authors: Lin
authors: Albert
authors: A
authors: Hofman
authors: Yu
authors: Y
authors: Hu
authors: Xiaoming
authors: X
authors: Li
authors: Wanyuan
authors: W
authors: He
authors: Johannes
authors: J
authors: Jeekel
authors: Xuejuan
authors: X
authors: Jin
authors: Jian
authors: J
authors: Gao
authors: Naiqing
authors: N
authors: Zhao
authors: Xin
authors: X
authors: Gao
mesh_terms: D017677:Age Distribution; D000368:Aged; D000419:Albuminuria / Q000208:ethnology* / Q000378:metabolism; D044466:Asian People / Q000706:statistics & numerical data*; D001786:Blood Glucose / Q000378:metabolism; D002340:Carotid Artery Diseases / Q000000981:diagnostic imaging / Q000208:ethnology* / Q000378:metabolism; D059168:Carotid Intima-Media Thickness; D002681:China / Q000453:epidemiology; D003404:Creatinine / Q000652:urine; D005260:Female; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D001786:Blood Glucose; D003404:Creatinine