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(Circulation. 2006;113:e406-e407.)
© 2006 American Heart Association, Inc.

Correspondence

Letter Regarding Article by Arnlov et al, "Low-Grade Albuminuria and Incidence of Cardiovascular Disease Events in Nonhypertensive and Nondiabetic Individuals"

Folkert W. Asselbergs, MD, PhD; P. van der Harst, MD; Wiek H. van Gilst, PhD

Department of Cardiology, University Medical Center Groningen, Groningen, The Netherlands, fwasselbergs@hotmail.com

An extract of the first 250 words of the full text is provided, because this article has no abstract.

To the Editor:

Recently, researchers from the Framingham Heart Study reported in Circulation that in middle-aged, nonhypertensive, nondiabetic subjects, low-grade albuminuria predicted the development of cardiovascular disease.¹ Subjects with previous coronary heart disease, diabetes mellitus, proteinuria, and hypertension (140/90 mm Hg) were excluded from these analyses. In addition to the strong prognostic value of urine albumin excretion in the lower range, another intriguing finding was reported: Baseline characteristics did not differ between subjects with urinary albumin excretion above or below the median. More specifically, body mass index, systolic and diastolic blood pressures, and smoking status did not differ between these groups. All of these factors have previously been reported to influence microalbuminuria.² In particular, blood pressure is strongly related to the presence and level of albuminuria. We believe that there is no apparent reason to assume that the cutoff value for blood pressure, below which blood pressure would not affect the level of microalbuminuria, be set at 140/90 mm Hg. Therefore, we question how the authors can explain the absence of any association between low-grade albuminuria and traditional cardiovascular risk factors in The Framingham Heart Study.

Disclosures

None.

1. Arnlov J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D, Benjamin EJ, D’Agostino RB, Vasan RS. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals: the Framingham Heart Study. Circulation. 2005; 112: 969–975.[Abstract/Free Full Text]

2. Barzilay JI, Peterson D, Cushman M, Heckbert SR, Cao JJ, Blaum C, Tracy RP, Klein R, Herrington DM. The relationship of cardiovascular risk factors to microalbuminuria in older adults with or without diabetes mellitus or hypertension: the Cardiovascular Health Study. Am J Kidney Dis. 2004; 44: 25–34.[CrossRef][Medline] [Order article via Infotrieve]

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Johan Ärnlöv, MD, PhD; Jane C. Evans, DSc; Thomas J. Wang, MD; Caroline S. Fox, MD, MPH; Emelia J. Benjamin, MD, ScM; Daniel Levy, MD; Ralph B. D’Agostino, PhD; Ramachandran S. Vasan, MD

From the National Heart, Lung, and Blood Institute, Framingham Heart Study, Framingham, Mass, vasan@bu.edu

James B. Meigs, MD, MPH

General Medicine Division, Massachusetts General Hospital, Boston, Mass

Response

We thank Dr Asselbergs and colleagues for their careful inspection of the Table in our report¹ and for their expert comments. Dr Asselbergs and colleagues concluded, based on the similarity of mean values of several cardiovascular disease risk factors in subjects with urine albumin–to–creatinine ratio (UACR) values above versus below the sex-specific median, that low-grade albuminuria was not associated with cardiovascular risk . . . [Full Text of this Article]

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