Increases in Urinary Albumin Excretion Predict Risk of Death From All Cases as Well as Those From Cardiovascular Disease
Urinary excretion of albumin predicts an increased risk of all-cause mortality, particularly cardiovascular mortality, according to researchers led by Hans L. Hillege, MD, of the Department of Cardiology at the University Hospital in Groningen, the Netherlands, in a report in this week’s issue of Circulation (Circulation. 2002;106:1777–1782).
In this study by the Prevention of REnal and Vascular ENd stage Disease (PREVEND) group, questionnaires about cardiovascular disease and cardiovascular morbidity, along with a vial to collect an early morning urine sample, were sent to 85 421 inhabitants of Groningen, the Netherlands, between 1997 and 1998. Of those contacted, 40 856 responded and 40 548 were included in the analysis. The urine was used to collect a measurement of urinary albumin concentration.
Later, researchers determined whether the subjects were alive by checking the municipal register. Cause of death was obtained from the Central Bureau of Statistics. During a follow-up period that averaged 961 days, 516 deaths of known cause were recorded for the cohort.
Researchers found a positive dose-response relationship between urinary albumin concentration and mortality. Higher urinary albumin concentration results increased the risk of both cardiovascular and noncardiovascular death after adjustment for other known cardiovascular risk factors. The increases were significantly higher for cardiovascular mortality than for other causes of death. A doubled concentration of urinary albumin was associated with a 1.29 relative risk of cardiovascular mortality and a 1.12 relative risk of death from other causes.
Aspirin or Warfarin: Is There a Better Antithrombotic Therapy?
Warfarin, either alone or in combination with aspirin, was superior to aspirin alone in reducing death, nonfatal infarction, or thromboembolic cerebral stroke after a myocardial infarction, according to Norwegian researchers in a report in the September 26, 2002 issue of the New England Journal of Medicine (N Engl J Med. 2002;347:969–974).
In this study, 3630 patients were randomized to one of three treatment groups: warfarin alone, aspirin alone, or warfarin plus aspirin. According to the authors, led by Mette Hurlen, MD, of the Medical Department of Ullevål University Hospital in Oslo, Norway, 241 of 1206 patients in the aspirin alone group, 203 of 1216 in the warfarin alone group, and 181 of 1208 in the warfarin plus aspirin group reached one of the end points. There was no statistical difference between the two groups receiving warfarin. However, major episodes of nonfatal bleeding occurred in 0.62% of patients per treatment-year in both warfarin groups and in 0.17% of patients per treatment-year of those receiving aspirin.
The Blood Pressure Difference
Differences in blood pressure among ethnic groups and between adolescent boys and girls exist without an unidentifiable cause, according to researchers in the September/October issue of Psychosomatic Medicine (Psychosom Med. 2002;64:707–713).
“The sex and ethnicity differences we observed in apparently healthy individuals may be important in explaining the ethnicity and sex differences in the prevalence of cardiovascular disease,” said lead study author Frank Treiber, PhD, of the Georgia Prevention Institute and the Departments of Pediatrics and Psychiatry at the Medical College of Georgia in Augusta.
Dr Treiber and his colleagues examined 9 blood samples from >200 adolescent study participants who were all healthy but who had a family history of cardiovascular diseases involving high blood pressure and early myocardial infarctions.
The blood samples were collected during 20 minutes of relaxation and during 2 stress tests, a 10-minute video game, and after the patients had had a plastic bag of crushed ice applied to their foreheads for a minute. Blood pressure measurements were taken multiple times throughout the study period.
Black participants, regardless of gender, had higher blood pressure increases than whites in response to the stressor. The researchers also found higher levels of endothelin-1, a blood vessel constrictor, in patients who were black. They found that male subjects had higher blood pressure than females, even during relaxation.
Exhaustion Has an Effect on Blood and Increases Heart Attack Risk
Dutch researchers say that vital exhaustion could increase blood clotting, leading to a heightened risk of heart attack. The research appears in the September/October 2002 issue of Psychosomatic Medicine (Psychosom Med. 2002;64:787–792).
According to researchers led by Rob van Diest, PhD, of the Department of Psychiatry and Neuropsychology at Maastricht University in the Netherlands, vital exhaustion is a state of excessive fatigue, irritability, and hopelessness. People experiencing this condition feel that everyday activities require immense effort and they find it very difficult to get motivated.
The researchers compared blood samples from 2 groups of 30 study participants. One group was classified as vitally exhausted after being given a 23-item questionnaire called the Maastricht examination for vital exhaustion. The control group tested negative for vital exhaustion.
Blood samples from the two groups were compared. Researchers found that the participants with vital exhaustion had higher levels of fibrinogen, which causes the blood to clot. They also found that subjects with vital exhaustion had early morning fibrinolysis during which the blood clots were broken down.
“We suggest that these (blood) changes provide a potential . . . mechanism by which vital exhaustion is related to a heart attack,” said van Diest in a released statement.