Is albuminuria a myocardial infarction risk equivalent for atherothrombotic events?

•Patients with albuminuria are at high risk for vascular events.•Albuminuria is a myocardial infarction risk equivalent.•Risk is highest in patients with albuminuria and prior myocardial infarction.

ObjectivePeople with chronic kidney disease frequently experience cardiovascular events. This study sought to investigate whether the presence of albuminuria displays a vascular risk equivalent to that in patients with prior myocardial infarction.MethodsAlbuminuria was defined as a urinary albumin to creatinine ratio of 30 μg/mg or greater in 852 consecutive patients undergoing coronary angiography. Prospectively, we recorded vascular events over 3.2 ± 1.2 years.ResultsFrom our patients, 513 (60.2%) had neither albuminuria nor a history of MI, 126 (14.8%) had albuminuria without prior MI, 137 (16.1%) did not have albuminuria but had a history of MI, and 76 (8.9%) had both, albuminuria and prior MI. Compared with the incidence of the composite endpoint among normoalbuminuric patients with no prior MI (11.9%), event rates nearly doubled both in patients with albuminuria without prior MI (24.6%; p = 0.003) and in normoalbuminuric patients with a history of prior MI (21.2%; p = 0.004) and were highest in patients with both, albuminuria and prior MI (36.8%; p < 0.001). Importantly, event rates were not significantly different between patients with albuminuria and no prior history of MI and those with normoalbuminuria but prior MI (p = 0.972). Moreover, the event rate in patients with both, albuminuria and history of MI, was significantly higher (p < 0.05) than in the two groups exhibiting only one of the two conditions.ConclusionThis is the first study demonstrating that albuminuria is a CAD risk equivalent. Thus, cardiovascular risk factors in albuminuric patients should be treated as aggressively as in patients with prior MI.