Cardiology: Prevention
by Nicole Lou, Senior Staff Writer, MedPage Today
December 19, 2023
Growing evidence points to kidney health as a major contributor to cardiovascular health, with the implication that there should be more testing and treatment for albuminuria starting in the current normal range.
The death risks of suboptimal cardiovascular health and a urinary albumin-to-creatinine ratio (UACR) in the high end of normal (<30 mg/g) were magnified when the two were put together, Xueli Yang, PhD, of Tianjin Medical University, China, and colleagues found from National Health and Nutrition Examination Survey (NHANES) data.
In addition to a near-linear correlation between UACR and risk of all-cause mortality, there appeared to be a significant multiplicative interaction of UACR and cardiovascular health such that mortality risk was especially high in people with high-normal UACR and moderate and poor cardiovascular health.
“The findings indicate that UACR elevation within the normal range may mediate 10.5% of the associations between poor CVH [cardiovascular health] and all-cause mortality, which further supports the importance of kidney function evaluation, particularly among populations with high cardiovascular risk,” the investigators reported in JAMA Network Open.
“Although further validation among independent populations is warranted, these findings underscore the importance of early identification of high-risk populations with normal UACR values through assessment of CVH, which might be helpful to target risk interventions in the future,” they concluded.
This is in line with UACR above normal being a known cardiovascular risk marker. Additionally, prior work had found albuminuria within the normal range to be tied to increased cardiovascular risk.
Recently, the AHA introduced cardiovascular-kidney-metabolic (CKM) syndrome as a health disorder covering overlaps in obesity, diabetes, chronic kidney disease, and cardiovascular disease. An estimated one in three U.S. adults have three or more risk factors of CKM syndrome.
Ladan Golestaneh, MD, MS, of Albert Einstein College of Medicine/Montefiore Medical Center in the Bronx, New York, commented that the bar for normal urinary albumin may need to be changed.
“Below the current cut off of 30 mg/g clinicians do not consider urinary albumin in any range as a factor in clinical decision making. Nor do they consider a high versus low range of urinary albumins below this cutoff as a meaningful risk marker. Clinicians may need to consider higher urinary albumins in the normal range as a risk marker for cardiovascular outcome at the very least,” she told MedPage Today.
“Future treatment guidelines may recommend treating within normal range higher albuminuria,” she added.
Yet there is a problem of inadequate testing for albuminuria in clinical practice in the first place, according to George Bakris, MD, of University of Chicago, who noted that only one in three people who need testing — namely people with type 2 diabetes and those with documented kidney disease — are actually getting it done.
