title: Different associations of albuminuria with total and cardiovascular mortality by concentrations of persistent organic pollutants in the elderly.
abstract: Epidemiologic studies have indicated that albuminuria is associated with mortality from all causes and cardiovascular disease (CVD), with substantial heterogeneity. We evaluated if the associations of urine albumin creatinine ratio (ACR) with all-cause and CVD mortality differed depending on serum concentrations of persistent organic pollutants (POPs), strong lipophilic chemical mixtures with very long half-lives, which are recently linked to many degenerative diseases. Study subjects were participants of the National Health and Nutrition Examination Survey 1999-2004 who were 60 years or older at baseline (n=1215 and 1067 for organochlorine pesticides (OCPs) and other POPs, respectively). They were followed-up through 2011 (mean follow-up periods: 8.1 and 8.0 years for OCPs and other POPs, respectively). The associations between the ACR and all-cause mortality significantly differed by the serum levels of POPs, especially organochlorine pesticides (OCPs; Pinteraction<0.01). Stratified analyses indicated that the associations between ACR and all-cause mortality became stronger as the serum levels of OCPs increased. Among the elderly with the highest tertile of OCPs, the adjusted hazard ratios were 1.0, 1.1, and 2.9 (Ptrend<0.01) across the categories of ACR (<10, 10-<30, and ≥30mg/g); however, ACR was not clearly related to mortality among the elderly with the lowest tertile of OCPs. CVD mortality showed similar interactions, as noted for all-cause mortality (Pinteraction<0.01). The different associations between albuminuria and mortality by the serum OCP levels and the little association among the elderly with low serum OCPs levels suggest that OCPs play an important role in albuminuria-related death risk. However, these findings need to be replicated in other cohort studies.
authors.affiliation: Department of Family Medicine, Hana General Hospital, 1262, 2sunhwan-ro, Heungdeok-gu, Cheongju 28378, Republic of Korea.
authors.forename: Hyun-Woo
authors.initials: HW
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, Hana General Hospital, 1262, 2sunhwan-ro, Heungdeok-gu, Cheongju 28378, Republic of Korea.
authors.forename: Jung-Hyun
authors.initials: JH
authors.lastname: Kim
authors.affiliation: Department of Family Medicine, Hana General Hospital, 1262, 2sunhwan-ro, Heungdeok-gu, Cheongju 28378, Republic of Korea.
authors.forename: Dong-Won
authors.initials: DW
authors.lastname: Lee
authors.affiliation: Department of Family Medicine, Hana General Hospital, 1262, 2sunhwan-ro, Heungdeok-gu, Cheongju 28378, Republic of Korea.
authors.forename: Sang-Hyun
authors.initials: SH
authors.lastname: Cho
authors.affiliation: Department of Family Medicine, Hana General Hospital, 1262, 2sunhwan-ro, Heungdeok-gu, Cheongju 28378, Republic of Korea.
authors.forename: Ji-Hoon
authors.initials: JH
authors.lastname: Jung
authors.affiliation: Department of Preventative Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-842, Republic of Korea.
authors.forename: Ki-Su
authors.initials: KS
authors.lastname: Kim
authors.affiliation: Department of Preventative Medicine, School of Medicine, Kyungpook National University, 680 Gukchaebosang-ro, Jung-gu, Daegu 700-842, Republic of Korea. Electronic address: lee_dh@knu.ac.kr.
authors.forename: Duk-Hee
authors.initials: DH
authors.lastname: Lee
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000097:blood* / Q000401:mortality*; D002318:Cardiovascular Diseases / Q000097:blood* / Q000401:mortality*; D004785:Environmental Pollutants / Q000097:blood*; D005260:Female; D006801:Humans; D006843:Hydrocarbons, Chlorinated / Q000097:blood*; D008297:Male; D008875:Middle Aged; D009749:Nutrition Surveys
chemical_list: D004785:Environmental Pollutants; D006843:Hydrocarbons, Chlorinated
keywords: Albuminuria; Interaction; Mortality; Organochlorine pesticides; Persistent organic pollutants