Key result
Macroalbuminuria linked to ~165% increased risk of incident stroke in meta-analysis.
Why the study?
It is unclear whether stroke incidence varies by level of albuminuria, despite known association of gross albuminuria with increased stroke risk.
Does higher level of albuminuria increase the risk of incident stroke?
Meta-Analysis (n=46,638)
Does higher level of albuminuria increase the risk of incident stroke?
Relative Risk: 2.65 (95% CI 2.25–3.14)
p-value: p=<0.001
Higher levels of albuminuria, even within the normal range, are proportionally associated with an increased risk of incident stroke.
Supports graded stroke risk stratification by albuminuria level; extends prior observational data but leaves open need for RCTs before practice change.
BACKGROUND: Gross albuminuria is associated with increased stroke risk, but it is unclear whether stroke incidence varies by level of albuminuria. We meta-analyzed prospective cohort studies to investigate the impact of various albuminuria levels and continuous urinary albumin excretion (UAE) change on stroke risk. METHODS: Systematic search for studies reporting quantitative estimates of the multivariate-adjusted relative risk (RR) and 95% CI for stroke risk associated with microalbuminuria (UAE 30-300 mg/day or nearest equivalent interval) and macroalbuminuria (UAE >300 mg/day) and studies that analyzed the relation of stroke with UAE continuously. Estimates were combined using a random-effect model. RESULTS: We identified seven studies comprising 46,638 participants with 1,479 stroke events. Incident stroke risk was greater for macroalbuminuria (RR 2.65, 95% CI 2.25-3.14) than microalbuminuria (RR 1.58, 95% CI 1.39-1.80), a difference that was significant (p for heterogeneity < 0.001, I(2) = 96%). In addition, risk of stroke increased proportionally with rising UAE (p < 0.001), even for UAE within normal range (beginning from levels as low as 2-4 mg/g). CONCLUSIONS: Higher albuminuria level confers greater stroke risk. These findings provide additional weight to evidence that albuminuria is strongly linked to stroke risk, and suggest that persons with elevated UAE levels may especially benefit from more intensive vascular risk reduction.
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Lee et al. (2010) conducted a meta-analysis in Stroke (n=46,638). Macroalbuminuria vs. Lower levels of urinary albumin excretion was evaluated on Incident stroke (RR 2.65, 95% CI 2.25-3.14, p=<0.001). Macroalbuminuria (RR 2.65; 95% CI 2.25-3.14) and microalbuminuria (RR 1.58; 95% CI 1.39-1.80) were associated with a significantly increased risk of incident stroke.
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