The comorbidity of increased arterial stiffness and microalbuminuria in a survey of middle-aged adults in China

Kidney Function and Aortic Stiffness, Pulsatility, and Endothelial Function in African Americans: The Jackson Heart Study

Rationale & Objective

The relation of vascular stiffness, endothelial function, and kidney function is incompletely elucidated in African Americans. Our hypothesis was that increased vascular stiffness and endothelial dysfunction are associated with low estimated glomerular filtration rate (eGFR) and albuminuria in African Americans.

Study Design

Cross-sectional cohort analysis of data from the Jackson Heart Study.

Settings & Patients

2,244 Jackson Heart Study participants (2012-2017 after Exam 3) who had undergone noninvasive hemodynamic assessment using arterial tonometry.

Predictors

Baseline carotid-femoral pulse wave velocity, pulsatile hemodynamics forward wave amplitude, and hyperemic brachial artery flow were measured. Reduced eGFR was defined as eGFR between 15 and 60 mL/min/1.73 m².

Outcomes

Prevalent albuminuria, urinary albumin-creatinine ratio.

Analytical Approach

2-sample t test for continuous variables and χ² test for categorical variables in addition to logistic and linear regression models to assess the risk for chronic kidney disease with each proposed hemodynamic variable.

Results

Among 2,244 participants, mean age was 66 ± 11 years and 64% were women. Reduced eGFR was present in 233 (10.4%), and elevated urinary albumin-creatinine ratio, in 232 (10.4%). In multivariable-adjusted analyses, higher carotid-femoral pulse wave velocity was associated with the presence of reduced eGFR (OR, 1.37 [95% CI, 1.08-1.75] per SD; P = 0.01) and with prevalent albuminuria (OR, 1.66 [95% CI, 1.32-2.11]; P < 0.001). Higher forward wave amplitude was significantly associated with prevalent albuminuria (OR, 1.37 [95% CI, 1.14-1.65]; P = 0.001).

Limitations

Cross-sectional analyses cannot inform causality.

Conclusions

Higher arterial stiffness and pulsatility are associated with higher odds of reduced eGFR in African Americans. Future studies should focus on whether improving arterial stiffness contributes to kidney protection in African Americans.

Metabolic syndrome and its components predict the development of arterial stiffening in a sample of adult men

BACKGROUND AND OBJECTIVE

Metabolic syndrome (MS) and its components are associated with greater cardiovascular risk. A number of studies found a positive association between MS and vascular damage, but few observational studies evaluated the predictive role of MS on arterial stiffening (AS). Therefore, the aim of this study was to estimate the ability of MS and its components to predict the risk of AS in an 8-year follow-up of a sample of adult men (Olivetti Heart Study).

METHODS

The analysis included 778 men without AS (pulse pressure >60 mmHg) at baseline. A positive diagnosis of MS was made by recognized criteria, if at least three components were present.

RESULTS

At the end of the follow-up period, there was an incidence of 11% in AS. The percentage of participants that developed AS was greater in the MS group than those without MS, also after adjustment for main confounders (odds ratio: 2.5, 95% confidence interval: 1.3-4.9). The risk of AS also increased with increase in the numbers of MS elements (p for trend <.01). In addition, the analysis of the predictive role of the single MS component showed that high blood pressure (HBP) was the strongest predictor.

CONCLUSIONS

The results of this prospective study indicate a predictive role of MS on AS, independently of main confounders. In addition, HBP seems the strongest predictor of AS among MS components.

Aortic Stiffness Index And Carotid Intima-Media Thickness Are Independently Associated With The Presence Of Microalbuminuria In Patients With Type 2 Diabetes Mellitus

PURPOSE

Microalbuminuria is a premature and widely used indicator of diabetic nephropathy and is reported to be related with a higher cardiovascular risk in diabetic patients. We aimed to examine whether the echocardiographic parameters, such as epicardial fat thickness (EFT), carotid intima-media thickness (CIMT) and aortic stiffness index (ASI) are associated with microalbuminuria in patients with diabetes mellitus type 2 (T2DM).

PATIENTS AND METHODS

A total of 272 consecutive patients were enrolled and after the exclusion criteria, the data of 180 patients with T2DM were used in this cross-sectional study. Patients were divided into two groups: 82 patients with microalbuminuria and 98 patients without microalbuminuria (normoalbuminuria). The laboratory results and echocardiographic EFT, CIMT and ASI parameters were noted.

RESULTS

Compared with the normoalbuminuria group, EFT, CIMT and ASI were significantly higher in the microalbuminuria group (p<0.05 for all). In logistic regression analysis; CIMT (OR: 3.15, p=0.024) and ASI (OR: 4.19, p=0.016) were independently associated with microalbuminuria in patients with T2DM.

CONCLUSION

In addition to CIMT, as a novel finding, ASI which is an indicator for the elastic properties of the aortic root was independently associated with microalbuminuria. CIMT and ASI measurement by echocardiography may be helpful in identifying the accompanying factors in the development of nephropathy.