title: Low-grade albuminuria and incidence of cardiovascular disease and all-cause mortality in nondiabetic and normotensive individuals.
abstract: BACKGROUND
  Recent studies indicate that, in people with diabetes or hypertension and in the general population, low-grade albuminuria (LGA) below the microalbuminuria threshold is a predictor for incidence of cardiovascular disease (CVD) and mortality. However, it remains unclear whether LGA predicts the risk of CVD incidence and death in nondiabetic and normotensive individuals.
  
  
  METHODS
  A total of 3599 individuals aged not less than 40 years from the general population who are free of CVD in nondiabetic and normotensive individuals with preserved glomerular filtration rate were followed for CVD incidence and all-cause death. LGA was defined as urinary albumin to creatinine ratio (UACR) less than 30  mg/g. It was examined whether there is an association between LGA and CVD incidence or all-cause death.
  
  
  RESULTS
  During the average 5.9 years of follow-up, 61 individuals had first CVD events, and 85 individuals died. The hazard ratios (HRs) for CVD incidence and all-cause death after full adjustment by potential confounders increased significantly in the top tertile of LGA (UACR ≥ 9.6  mg/g for men, ≥ 12.0  mg/g for women) compared with the first tertile [HR = 2.79, 95% confidence interval (CI), 1.41-5.52, HR = 1.69, 95% CI, 1.00-2.84, respectively]. Population-attributable fractions of the top tertile of LGA for CVD incidence and all-cause death were 37.9 and 20.1%, respectively.
  
  
  CONCLUSIONS
  In apparently healthy individuals with optimal blood pressure and no diabetes, LGA independently predicts CVD incidence and all-cause death, particularly with the large contribution to the excessive incidence of CVD.
authors.affiliation: aDepartment of Internal MedicinebDepartment of Hygiene and Preventive MedicinecDepartment of NeurosurgerydDepartment of Neurology, Iwate Medical UniversityeDepartment of Health and Physical Education, Faculty of Education, Iwate University, MoriokafThe Research Institute of Strategy for Prevention, Tokyo, Japan.
authors.forename: Fumitaka
authors.initials: F
authors.lastname: Tanaka
authors.forename: Ryosuke
authors.initials: R
authors.lastname: Komi
authors.forename: Shinji
authors.initials: S
authors.lastname: Makita
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Onoda
authors.forename: Kozo
authors.initials: K
authors.lastname: Tanno
authors.forename: Masaki
authors.initials: M
authors.lastname: Ohsawa
authors.forename: Kazuyoshi
authors.initials: K
authors.lastname: Itai
authors.forename: Kiyomi
authors.initials: K
authors.lastname: Sakata
authors.forename: Shinichi
authors.initials: S
authors.lastname: Omama
authors.forename: Yuki
authors.initials: Y
authors.lastname: Yoshida
authors.forename: Kuniaki
authors.initials: K
authors.lastname: Ogasawara
authors.forename: Yasuhiro
authors.initials: Y
authors.lastname: Ishibashi
authors.forename: Toru
authors.initials: T
authors.lastname: Kuribayashi
authors.forename: Akira
authors.initials: A
authors.lastname: Okayama
authors.forename: Motoyuki
authors.initials: M
authors.lastname: Nakamura
mesh_terms: D000328:Adult; D000368:Aged; D000419:Albuminuria / Q000453:epidemiology*; D001794:Blood Pressure; D002318:Cardiovascular Diseases / Q000453:epidemiology*; D002423:Cause of Death; D015331:Cohort Studies; D016757:Death, Sudden, Cardiac / Q000453:epidemiology; D005260:Female; D005919:Glomerular Filtration Rate; D006333:Heart Failure / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D020521:Stroke / Q000453:epidemiology