Abstract 11625: Do Changes of Urinary Albumin Excretion Predict Cardiovascular Events? A Meta-regression Analysis of 32 Randomized Trials

Abstract

Background: The association between urinary albumin excretion (UAE) and cardiovascular (CV) risk has been well established. However, it has been not demonstrated whether regression of UAE is associated with reduced CV risk. The aim of the current study was to evaluate the relationship between changes of UAE induced by pharmacologic therapies and CV events.

Methods: the MEDLINE, Cochrane, ISI Web of Science and SCOPUS database were searched for articles about UAE until May 2012. Randomized trials assessing UAE at baseline and at the end of follow-up and reporting CV clinical end-points (all-cause death, myocardial infarction, cerebrovascular accidents and CV death) were included in the study. Meta-regression analysis was performed to test the relationship between UAE changes and clinical end-points. The influence of baseline patients’ characteristics, follow-up, study publication year, Detsky quality score, AUE at baseline, comorbidities and concomitant pharmacological treatments were also explored. Mecaskill’s modified test was used to assess publication bias.

Results: 32 trials enrolling 22,022 participants were included. In meta-regression analysis, a relationship between UAE changes from baseline to the end of follow-up and risk of myocardial infarction (change in Tau2 (t)=2.35; p Tau (p)=0.030)(Figure) was found, whereas UAE changes did not correlate with cerebrovascular accidents (t=0.21; p=0.840), CV death (t=1.55; p=0.145) and all-cause death (t=0.37; p=0.716). Results were confirmed by sensitivity analysis. No heterogeneity among studies or publication bias were detected.

Conclusions: changes in UAE predict the risk of myocardial infarction, indicating that UAE monitoring represents a valuable therapeutic target in high risk patients.