Microalbuminuria in Patients of Acute Coronary Syndrome and Its Correlation with Fasting Lipid Profile
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
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