Relation between albumin in the urine and electrocardiographic markers of myocardial ischemia in patients without diabetes mellitus.

Background—The electrocardiogram (ECG) can be used to determine the presence of ischemic heart disease in a population at large. In addition, there is evidence that microalbuminuria increases cardiovascular risk in nondiabetic populations. Little is known about the precise relation between urinary albumin excretion (UAE) and cardiovascular disease. If UAE can be considered as a continuous variable this could have important implications for individual cardiovascular risk assessment. We evaluated the association between the level of UAE, including levels within the normal range, and ischemic electrocardiographic (ECG) abnormalities in a general nondiabetic population. Methods and results— In a population-based study 7,579 subjects (mean age 48 years, 51 % male) were eligible for analysis. UAE was measured as the mean of two 24-hour urine collections. Using computerized Minnesota coding, ischemic ECG abnormalities were divided into: infarct patterns, major ischemia, and minor ischemia. Furthermore, T axes deviations, as potentially more sensitive markers of cardiac disease, were categorized as normal, borderline, and abnormal. The presence of all ECG abnormalities increased with increasing levels of UAE, which was already seen at levels of UAE below 30 mg/24h. After adjustment for other cardiovascular risk factors UAE remained significantly associated with major ischemia (Odds Ratio, [95% CI] 1.13, [1.00-1.27]) and abnormal T-axis deviation (1.29, [1.10-1.51]). Conclusions— In a large nondiabetic population a graded continuous relation was present between the level of UAE and ECG abnormalities, without an apparent threshold. In addition, UAE was associated with several ECG abnormalities, independent from conventional cardiovascular risk factors. These data suggest that the level of UAE can be used for establishing cardiovascular risk in the population at large. Urinary albumin excretion and ECG markers of myocardial ischaemia 83