Microalbuminuria in Patients of Acute Coronary Syndrome and Its Correlation with Fasting Lipid Profile
Abstract
BACKGROUND:
Microalbuminuria has recently been linked with the development of atherosclerosis and coronary artery disease. It has been detected in the urine of patients after Myocardial Infarction and is established as an independent risk factor for the development of ischemic heart disease and evenclinically negligible levels of microalbuminuria i.e., below 1mg/mmol, are associated with increased cardiovascular risk. The association of microalbuminuria with dyslipidemia is significant and patients with dyslipidemia have underlying urine albumin excretion which puts them at risk of developing atherosclerotic coronary artery disease. Therefore, if asymptomatic patients with dyslipidemia are screened for microalbuminuria, prevention of major adverse cardiovascular events (MACE) can be done effectively.
AIMS AND OBJECTIVES: To observe the frequency of urinary albumin excretion in hospitalized patients with acute coronary syndrome and to establish its correlation with Fasting Lipid profile.
MATERIAL AND METHODS: This prospective analytical study was done at Cardiology department of Mayo Hospital, Lahore over six months on 139 patients using non probability purposive sampling technique. Sample size of 139 patients is calculated by using 90% confidence level, 7% margin of error and by taking expected percentage of microalbuminuria in acute coronary artery disease patients as 50%. The patients and chaperones were briefed and instructed to collect the first urine sample in the early morning in a sterile container provided to them. Fasting blood sugar (FBS), Total cholesterol, Triglycerides (TG), High density lipoprotein (HDL), Low density lipoprotein (LDL), and very low density lipoprotein (VLDL) were measured by automated enzymatic method. Serum creatinine and urinary creatinine were measured by kinetic calorimetric method. Microalbuminuria (MA) was measured by urine dip stick method. Albumin creatinine ratio was calculated. The levels of Microalbuminuria were compared with the lipid profile. The patients were followed at regular monthly intervals up to six months and their Microalbuminuria levels and fasting lipid profile were measured and analyzed. In addition, the Microalbuminuria level of patients undergoing coronary angiography was compared and analyzed according to the number of diseased vessels. Patients presenting with Acute ST Elevation myocardial infarction, NSTEMI and unstable angina were included. Patients with history of Diabetes mellitus, Systemic hypertension, Urinary tract infection, Nephropathy(serum creatinine >1.0mg/dl), Old MI and AMI following surgery and major trauma, Patients on Statin Therapy, Patients on ACE Inhibitors and Patients with UAE > 300 mg were excluded from the study. Data entry and analysis was done with SPSS 23.
RESULTS: A total of 139 patients were included in the study. There were 100(71.9%) male and 39(28.1%) female cases with male to female ratio of 2.56 :1.The mean age of patients was 51.51 ± 11.97 years with age range of 52 (28 and 80 as minimum and maximum value). Microalbuminuria was found in 120(86.3%) of the cases.
CONCLUSION: Overall higher frequency of microalbuminuria, raised LDL and TG were observed in 86.3%, 71.2% and 59% of cases respectively, however lower than minimally acceptable level of HDL were found in 52.5% of cases. In Conclusion, parallel relationship between microalbuminuria and raised LDL and TG is found.
KEYWORDS: Acute coronary syndrome, Urinary albumin, Microalbuminuria, Fasting Lipid profile
References
Mathers C. The global burden of disease: 2004 update: World Health Organization; 2008.
Gersh BJ, Sliwa K, Mayosi BM, Yusuf S. Novel therapeutic conceptsThe epidemic of cardiovascular disease in the developing world: global implications. Eur Heart J 2010;31(6):642-8
Goyal A, Yusuf S. The burden of cardiovascular disease in the Indian subcontinent. Indian J Med Res 2006;124(3):235-44.
Pesek K, Pesek T, Rogini? Sa. The Importance of Risk Factors Analysis in the Prevention of Cardiovascular Disease (CVD). Atherosclerotic Cardiovascular Disease: InTech; 2011.
Ray KK, Cannon CP, Cairns R, Morrow DA, Rifai N, Kirtane AJ, et al. Relationship between uncontrolled risk factors and C-reactive protein levels in patients receiving standard or intensive statin therapy for acute coronary syndromes in the PROVE IT-TIMI 22 trial. J Am Coll Cardiol 2005;46(8):1417-24.
Chhabra N. Endothelial dysfunction–A predictor of atherosclerosis. Internet J Med Update 2009;4(1):33-41.
Singh A, Satchell SC. Microalbuminuria: causes and implications. Pediatr Nephrol 2011;26(11):1957-65.
Xia F, Liu G, Shi Y, Zhang Y. Impact of microalbuminuria on incident coronary heart disease, cardiovascular and all-cause mortality: a meta-analysis of prospective studies. Int J Clin Exp Med 2015;8(1):1-9.
Nagai H, Suzuki S, Ishii H, Shibata Y, Harata S, Takayama Y, et al. Impact of low-grade albuminuria on left ventricular diastolic dysfunction. IJC Metabolic & Endocrine 2015;6:13-6.
Berton G, Cordiano R, Palmieri R, Cucchini F, De Toni R, Palatini P. Microalbuminuria during acute myocardial infarction; a strong predictor for 1-year mortality. Eur Heart J 2001;22(16):1466-75.
Ärnlöv J, Evans JC, Meigs JB, Wang TJ, Fox CS, Levy D, et al. Low-grade albuminuria and incidence of cardiovascular disease events in nonhypertensive and nondiabetic individuals. Circulation 2005;112(7):969-75.
Katz DH, Selvaraj S, Aguilar FG, Martinez EE, Beussink L, Kim K-YA, et al. Association of Low-Grade Albuminuria with Adverse Cardiac Mechanics: Findings from the HyperGEN Study. Circulation 2013:CIRCULATIONAHA. 113.003429.
Parvez A, Khan S, Rizvi I, Zafar L, Khan H. Prevalence of microalbuminuria in acute myocardial infarction and its correlation with Cardiac Troponin-I. Biomed Res 2012;23(1):93-7.
Hashim R, Nisar S, Rehman K, Naqi N. Microalbuminuria: Association with ischemic heart disease in non-diabetics. J Ayub Med Coll Abbottabad 2006;18(1):40-3.
Lekatsas I, Koulouris S, Triantafyllou K, Chrisanthopoulou G, Moutsatsou-Ladikou P, Ioannidis G, et al. Prognostic significance of microalbuminuria in non-diabetic patients with acute myocardial infarction. Int J Cardiol 2006;106(2):218-23.
Bahia L, Gomes MB, Cruz PdMd, Gonçalves MdF. Coronary artery disease, microalbuminuria and lipid profile in patients with non-insulin dependent diabetes mellitus. Arq BrasCardiol 1999;73(1):17-22.
Lazzeri C, Valente S, Chiostri M, PIcariello C, Gensini GF. Microalbuminuria in hypertensive nondiabetic patients with ST elevation myocardial infarction. J Cardiovasc Med 2010;11(10):748-53.
Apostolovic S, Stanojevic D, Djordjevic V, Tomasevic RJ, Martinovic SS, Radojkovic DD, et al. Prognostic significance of microalbuminuria in patients with acute myocardial infarction. Clin Lab 2010;57(3-4):229-35.
Tanaka S, Takase H, Dohi Y, Kimura G. The prevalence and characteristics of microalbuminuria in the general population: a cross-sectional study. BMC Res Notes 2013;6(1):1-7.
Metcalf PA, Scragg RK. Epidemiology of microalbuminuria in the general population. J Diabet Complicat 1994;8(3):157-63.
Tebbe U, Bramlage P, Thoenes M, Paar WD, Danchin N, Volpe M, et al. Prevalence of microalbuminuria and its associated cardiovascular risk: German and Swiss results of the recent global i-SEARCH survey. Swiss Med wkly 2009;139(33):473-80.
Sathisha T, Manjunatha Goud B, Avinash S, Jeevan Shetty OSD, Devaki R. Microalbuminuria in Non-diabetic, Non-hypertensive Myocardial Infarction in South Indian Patients with Relation to Lipid Profile and Cardiac Markers. J Clinic Diagnos Res 2011;5(6):1158-60.
Awan ZA, Naveed AK, Malik MM, Khan S. Microalbuminuria in Angiographically Documented Coronary Heart Disease in Non Diabetic and Normotensive Individuals. Ann KEMU 2009;15(3):111-6.
Gosling P, Hughes E, Reynolds T, Fox J. Microalbuminuria is an early response following acute myocardial infarction. Eur Heart J 1991;12(4):508-13.
Berton G, Cordiano R, Palatini P. Albuminuria during acute myocardial infarction and prognosis: a methodological issue. J Cardiovasc Med 2011;12(5):376-7.
Taskiran M, Iversen A, Klausen K, Jensen GB, Jensen JS. The association of microalbuminuria with mortality in patients with acute myocardial infarction. A ten-year follow-up study. Heart international 2010;5(1):7-9.
Weir MR. Microalbuminuria and cardiovascular disease. Clin J Am Soc Nephrol 2007;2(3):581-90.
Malani PN. Harrison’s principles of internal medicine. JAMA 2012;308(17):1813-4.
Pradhep RS, Janakiram N, Benjamin VP, Natarajan S. A Study of Microalbuminuria in Coronary Artery Disease among Non-Diabetic Individuals. Int J Curr Microbiol App Sci 2017;6(1):344-61.
Zeeshan A, Ahmad Z, Tahir GA, Yaqoob Y. ACUTE CORONARY SYNDROME. Professional Med J 2017;24(1):26-30.
Al-Saffar HB, Nassir H, Mitchell A, Philipp S. Microalbuminuria in non-diabetic patients with unstable angina/non ST-segment elevation myocardial infarction. BMC 2015;8(1):371.
Khosravi A, Avesta L, Kelishadi R, Ramezani MA, Bahonar A, Heydari H, et al. Assessment of relation between microalbuminuria and ischemic electrocardiogram in Iranian general population. ARYA Atheroscler 2010;5(1).
Diercks G, Van Boven A, Hillege H, Janssen W, Kors J, De Jong P, et al. Microalbuminuria is independently associated with ischaemic electrocardiographic abnormalities in a large non-diabetic population. The PREVEND (Prevention of REnal and Vascular ENdstage Disease) study. Eur Heart J 2000;21(23):1922-7.
Cosson E, Pham I, Valensi P, Pariès J, Attali J-R, Nitenberg A. Impaired coronary endothelium–dependent vasodilation is associated with microalbuminuria in patients with type 2 diabetes and angiographically normal coronary arteries. Diabetes Care 2006;29(1):107-12.
Mann JF, Gerstein HC, Pogue J, Bosch J, Yusuf S. Renal insufficiency as a predictor of cardiovascular outcomes and the impact of ramipril: the HOPE randomized trial. Ann Intern Med 2001;134(8):629-36.
Schmieder RE, Schrader J, Zidek W, Tebbe U, Paar WD, Bramlage P, et al. Low-grade albuminuria and cardiovascular risk. Clin Res Cardiol 2007;96(5):247-57.
