Urine albumin-to-creatinine ratio and asymptomatic intracranial atherosclerotic stenosis in hypertensive patients.

Intracranial atherosclerotic stenosis (ICAS) contributes to nearly 50% of stroke in China, especially in patients with hypertension. Urine albumin-to-creatinine ratio (ACR) has been related to stroke and other atherosclerotic cardiovascular diseases. However, there is limited information about the association of ACR and early impairment of cerebral vessels. Hereby we assessed the association of ICAS with ACR, estimated glomerular filtration rate (eGFR), and dipstick proteinuria in a stroke-free hypertensive population. We included 889 hypertension patients aged ≥60 years without prior stroke. Computed tomography angiography was performed to detect ICAS. ACR and dipstick proteinuria were tested from a random spot urine. eGFR was calculated using the CKD-EPI equation. Logistic regression was carried out to analyze the association of renal function with the presence, extent, and lesion number of ICAS. Elevated ACR (≥30 mg/g) was associated with ICAS after adjustment of confounding factors (odds ratio (OR) = 1.66, 95% confidence interval (CI): 1.21-2.29). Patients with elevated ACR were more prone to develop moderate-to-severe stenosis (OR = 1.57, 95% CI: 1.16-2.14) and more lesions (OR = 1.58, 95% CI: 1.16-2.15). Such association was independent of previously identified cardiovascular risk factors. No significant association was detected between ICAS and dipstick proteinuria or eGFR after adjustment. Our findings suggested that elevated ACR was associated with asymptomatic ICAS in an aged stroke-free hypertensive population.

Association of high body lead store with severe intracranial carotid atherosclerosis.

OBJECTIVE: Lead is involved in the pathogenesis of atherosclerosis and hypertensive disease and may be related to cerebrovascular disease. We studied the association of body lead level with stroke subtypes and severity of cerebral atherosclerosis in order to identify the significance of lead exposure to cerebrovascular disease. METHODS: From April, 2002 to March, 2005, we studied the lead level in all patients receiving digital subtraction angiography. Diameter stenosis at extracranial carotid, intracranial carotid and vertebrobasilar system was calculated according to the NASCET criteria. A blood sample and a mobilization test of 72-h urine sample were collected for lead measurement. RESULTS: In a total of 213 subjects, 19 were free of stroke (blood lead level=4.62+/-2.41 microg/dL, body lead store=39.04+/-20.91 microg) and 194 were stroke patients (4.89+/-2.75 microg/dL, 45.13+/-29.8 microg; all stroke vs. non-stroke, P>0.05). In the 153 subjects with atherosclerotic origin, body lead store but not blood lead level in the intracranial carotid system was significantly higher in > or =50% group than <50% group (blood lead: 5.61+/-3.02 microg/dL vs. 4.80+/-2.50 microg/dL, Student's t-test, P=0.129; body lead store: 51.7+/-27.0 microg vs. 41.9+/-23.5 microg, Student's t-test, P=0.038, multivariate logistic regression, odds ratio=1.02, 95% CI: 1.00-1.03, P=0.043). However, there was no significant association between lead level and stenotic severity in extracranial and vertebrobasilar systems (P>0.05). CONCLUSION: Our study demonstrated that long-term lead exposure as measured by body lead store might carry a potential risk of intracranial carotid atherosclerosis.

Relationship between serum uric acid concentration, metabolic syndrome and carotid atherosclerosis.

OBJECTIVE: Carotid intima-media thickness (IMT) is a useful surrogate marker of cardiovascular disease. Associations between hyperuricemia, metabolic syndrome and carotid IMT have been reported, but few of the studies have been conducted in a Japanese population. METHODS: A total of 1,128 subjects (498 men aged, 68+/-14 years and 630 women aged 72+/-12 years) were divided into 4 groups according to serum uric acid (SUA) quartiles. We first investigated the association between SUA concentrations and metabolic syndrome; then, we assessed whether there is an independent association of SUA with carotid IMT in a population subdivided according to gender and metabolic syndrome status. RESULTS: In women, the prevalence of visceral obesity and metabolic syndrome were significantly increased with increased SUA quartiles, but not in men. After adjusting for age, smoking status, LDL-cholesterol, creatinine and history of diabetes mellitus, the odds ratios (95% CI) of sex-specific quartiles of SUA for metabolic syndrome were 1.0, 1.37 (0.79-2.37), 1.37 (0.79-2.38), and 1.80 (1.03-3.15) in men, and 1.0, 1.04 (0.56-1.94), 2.35 (1.30-4.22), and 2.20 (1.16-4.20) in women. After adjusting for various known risk factors, the prevalence of carotid atherosclerosis (IMT> or =1.0 mm) was higher in subjects in the second, third and fourth quartiles of SUA concentration with odds ratios (95% CI) of 2.41 (1.08-5.37), 3.33 (1.49-7.42), and 2.73 (1.17-6.35), respectively in men without metabolic syndrome but not in men with metabolic syndrome or in women with or without metabolic syndrome. CONCLUSION: The prevalence of metabolic syndrome was significantly increased according to SUA values only in women. In men without metabolic syndrome, SUA was found to be an independent risk factor for incidence of carotid atherosclerosis.

[Significance of proteinuria in patients with acute ischemic brain disease]. / Znacaj proteinurije kod bolesnika sa akutnom ishemijskom bolescu mozga.

Brain vascular diseases are ranked the third as the cause of morbidity and mortality in majority of the countries of the world. In about 80% of the cases of vascular brain diseases, it is ischemic brain disease (IBD). Atherosclerosis of main cerebral arteries is most frequently responsible for the occurrence and development of IBD. In recent years it was reported for the first time of the association of atherosclerosis and/or its complications and proteinuria. Assuming that there exists the significant association between the degree of proteinuria and clinical parameters of IBD, the aim of this study was to investigate the frequency and patterns of the association of proteinuria and clinical IBD parameters. The study was performed in 180 patients with IBD of atherothrombotic origin and 60 patients with the diseases of non-vascular origin, as the control group. In all patients quantitative determination of proteinuria was performed, and in the patients with IBD was determined the degree of IBD and afterwards the degree of functional and neurologic impairment prior to and at the end of treatment in acute phase using the standardized scales. The results of the study revealed the existence of significant frequency of proteinuria in the patients with IBD, as well as the significant association between the degree of proteinuria and severity of IBD. It was concluded that proteinuria in patients with IBD was probably associated with the atherogenic processes and physiopathologic processes of IBD, respectively, which could have predictive value for the outcome of the disease in the early stage.

Cyclic AMP excretion in urines of patients with subarachnoid hemorrhages.

Urinary excretion of cAMP was closely monitored for several days in 74 patients with subarachnoid hemorrhages. A rise in urinary cAMP up to 45 microM/24h was observed (normal values being 1 to 5 microM/24h). Patients with associated metabolic disorders were excluded from this study. We have found a correlation between the severity of the clinical conditions, recovery from acute disorder and cAMP excretion, thus suggesting that an increase of urinary cAMP level is related to the extent and the evolution of the acute cerebral damage.

[Sulfur-containing substances in the urine and blood of patients with cerebral circulatory disorders]. / Serosoderzhashchie veshchestva v moche i krovi u bol'nykh s rasstroistvami mozgovogo krovoobrashcheniia.

In 138 patients (87 males and 51 females) with hypertensive disease (90 cases) and atherosclerosis (48 cases) the authors studied the content of sulfur and its fractions in the blood and the level of excretion with urine in disturbances of cerebral circulation. In hypertensive disease and cerebral atherosclerosis, complicated by disturbances of cerebral circulation, there were quantitative changes in the level of sulfur-containing substances both in the blood serum and urine. Disorders in the sulfur metabolism indicate a drop of the autotoxic function in the liver, quite possibly related to the influence of pathological changes proceeding in the central nervous system.