Relation of urinary albumin excretion to coronary heart disease and low renal function: role of blood pressure.

BACKGROUND: Previous studies report that urinary albumin excretion is associated with coronary heart disease (CHD). The present epidemiologic study investigated if (1) blood pressure status affects the association of urinary albumin excretion with CHD; and (2) urinary albumin excretion is associated with low renal function also. METHODS: The cross-sectional association was analyzed of overnight urinary albumin excretion with prevalence of CHD (myocardial infarction and/or ischemia as defined by standard electrocardiogram) and low renal function (overnight creatinine clearance <60 mL/min) in a population sample of 1632 men and women with ages 45 to 64 years. Hypertension, hypercholesterolemia, smoking habit, and diabetes mellitus were included in analyses. RESULTS: CHD prevalence was in the whole sample 8.2% (N= 134), in the hypertensive subgroup 11.9% (N= 79), and in the nonhypertensive subgroup 5.7% (N= 55). For the association between urinary albumin excretion (logarithm-transformed due to skewed distribution) and CHD, the multivariate logistic coefficient with 95% CI was significant in the whole sample (+0.79, 95% CI =+0.32/+1.26, P < 0.001) and in the hypertensive subgroup (+0.97, 95% CI =+0.70/+1.24, P < 0.001), not in the nonhypertensive subgroup (-0.06, 95% CI =-0.80/+0.68, P= 0.997). Prevalence of low creatinine clearance was in the whole sample 4.0% (N= 66), in the hypertensive subgroup 4.8% (N= 32), and in the nonhypertensive subgroup 3.5% (N= 34). The logistic coefficient between urinary albumin excretion and low creatinine clearance was borderline significant in the whole sample (+0.56, 95% CI =-0.02/+1.14, P= 0.090), significant in the hypertensive subgroup (+0.73, 95% CI =+0.04/+1.42, P= 0.044), not significant in the nonhypertensive subgroup (-0.07, 95% CI =-1.25/+1.10, P= 0.913). CONCLUSION: Results support the use of urinary albumin excretion as marker of CHD and slightly reduced renal function in hypertensives.

Cross-sectional and prospective data on urinary calcium and urinary stone disease.

BACKGROUND: Urinary calcium is considered a risk factor for urinary stone disease (USD), although prospective data are missing. This epidemiologic study investigates cross-sectionally and longitudinally the relation of urinary calcium excretion to USD. METHODS: In the Gubbio Population Study, data on USD were collected by questionnaire during medical examinations from 1989 to 1992 (baseline) and telephone interviews in 1997 to 1998 (follow-up). Baseline data collection included overnight urinary calcium excretion and use of medications. Study cohort was made of 1458 men and 1799 women, age 25 to 74 years, and not on treatment with diuretics at baseline. USD was diagnosed by: excretion of stone(s), and/or radiographic or ultrasonic evidence, and/or surgical or endoscopic removal of stone(s). RESULTS: At baseline, urinary calcium excretion was higher in persons with than without USD (215 and 182 micromol/hour, P < 0.001) and related to USD prevalence independent of gender, age, and other variables (P < 0.001). Among persons without USD at baseline, baseline urinary calcium excretion was higher in persons with than without incident USD at follow-up (202 and 181 micromol/hour, P = 0.034) and related to incident USD independent of gender, age, and other variables. A difference of 100 micromol/hour (about 1 SD) in urinary calcium excretion related to a difference in USD risk of 1.32 for prevalence and 1.21 for incidence (95% CI = 1.15/1.52 and 1.01/1.45, respectively) in multivariate analyses controlled for gender, age, body mass index, parental history of USD, urinary excretion of urea, sodium, and potassium. CONCLUSION: Cross-sectional and prospective data show that urinary calcium excretion is a risk factor for USD.

Selection of thrombogenetic antiphospholipid antibodies in cerebrovascular disease patients.

BACKGROUND AND PURPOSE: The association between anticardiolipin antibodies (aCL) and thrombosis is well recognized, but its role as an independent risk factor for stroke is not. The study's aim was to investigate the presence of antiphospholipid antibodies (aPL) and ischemic vascular events by using both traditional means the estimation of aCL and glycoprotein (beta(2)GP1) antibodies. Additionally both aCL/beta(2)GP1 and aPLmix/beta(2)GP1 antibodies were measured. The measurement of these two antibodies was determined by using as target antigens, either cardiolipin alone or a mixture of different phospholipids coated with human beta(2)GP1 in order to select only the autoimmune antibodies. One hundred and twenty-two consecutive patients with first-ever acute ischemic cerebrovascular event were included and compared with controls. The presence of aCl in patients (20.5 %) and controls (14.7 %) was not significantly different (p = 0.1). The presence of abeta(2)GP1 (6.5 % versus 4.9 %, p = 0.7) was also not significant, while there were associations for aCL/b2GP1 13.9 % versus 4.9 % (p = 0.02) and aPLmix/beta(2)GP1 15.6 % versus 4.9 % (p = 0.01). These latter tests seem to be useful in assessing the autoimmune and therefore the thrombogenetic antibodies.

Phospholipid autoantibodies: time for a new immuno-assay?

Antiphospholipid (aPL) antibodies are a wide and heterogeneous group of closely related immunoglobulins that have specificity for a number of phospholipids (PLs), PL-binding proteins, including beta2 glycoprotein I (beta2GP1), prothrombin, and PL-protein complexes. Antiphospholipid antibodies are currently detected by a standard solid-phase immunoassay such as anticardiolipin (aCL) antibodies. Although the association between aCL antibodies and thrombosis is well recognized, their role in stroke pathogenesis, and the possibility that they are an independent stroke risk factors in the general stroke population, remains to be determined. There are other negatively charged PL, largely represented within the cellular membrane and involved in the coagulation. Different studies have demonstrated a positive correlation among other aPL and stroke.