Microalbuminuria is a negative correlate for cognitive function in older adults with peripheral arterial disease: results from the US National Health and Nutrition Examination Survey 1999-2002
Microalbuminuria is a negative correlate for cognitive function in older adults with peripheral arterial disease: results from the US National Health and Nutrition Examination Survey 1999-2002
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DOI：
10.1111/j.1365-2796.2007.01847.x
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发表时间：
2007-11-01
影响因子：
11.1
通讯作者：
Yu, Y.-H.
中科院分区：
文献类型：
--
作者：
Kuo, H.-K.;Lin, L.-Y.;Yu, Y.-H.
目标.微量白蛋白尿（MA）已越来越多地被确定为心血管风险的标志物。虽然不良的认知功能被认为是心血管负担增加的后遗症，但对MA和认知功能之间的关系知之甚少。基于人口的横断面研究。1999-2002年美国国家健康与营养调查。分析了2049名非住院成人（≥ 60岁）的认知测试、尿白蛋白/肌酐比值（UACR）和踝臂血压指数（ABPI）的非缺失值。排除UACR > 300 μ g mg（-1）的参与者。UACR以μ g mg（-1）为单位，通过将尿白蛋白值除以尿肌酐浓度来计算。MA定义为UACR在30和300 μ g mg（-1）之间。认知功能通过2分钟数字符号替代测试（DSST）测量。外周动脉疾病（PAD）定义为ABPI < 0.9。总体而言，在控制年龄、性别、种族、体重指数和文化程度后，MA与DSST评分呈负相关（回归系数=-2.8，P = 0.002）。PAD对MA和DSST评分之间的相关性有影响。在PAD参与者中，经多变量调整后，MA参与者的DSST评分低于无MA参与者（β =-6.3，P = 0.003）。此外，UACR最高四分位数中PAD的参与者的DSST评分显著低于最低四分位数中的参与者（β =-8.7，P = 0.001）。在没有PAD的参与者中，MA和认知功能之间没有关联。我们观察到MA和PAD对DSST评分的累加效应。MA和PAD患者的DSST平均评分低于非MA和PAD患者（β =-6.2，P = 0.003）。MA的存在或更高水平的尿白蛋白排泄与PAD参与者的认知功能呈负相关。
Objectives. Microalbuminuria (MA) has been increasingly identified as a marker of cardiovascular risk. Although poor cognitive function has been implicated as a sequelae of increased cardiovascular burden, little is known about the association between MA and cognitive function.Design. Population-based cross-sectional study.Settings. National Health and Nutrition Examination Survey 1999-2002 in the USA.Subjects. 2049 noninstitutionalized adults (>= 60 years) with nonmissing values in cognitive test, urinary albumin-to-creatinine ratio (UACR) and ankle-brachial blood pressure index (ABPI) was analysed. Participants with UACR > 300 mu g mg(-1) were excluded.Main outcome measures. The UACR, in the unit of mu g mg(-1), was calculated by dividing the urinary albumin value by the urinary creatinine concentration. MA was defined as UACR between 30 and 300 mu g mg(-1). Cognitive function was measured by a 2-min Digit Symbol Substitution Test (DSST). Peripheral artery disease (PAD) was defined as an ABPI < 0.9 in either leg.Results. Overall speaking, MA was inversely associated with DSST score after controlling for age, sex, race, body mass index and educational level (regression coefficient = -2.8, P = 0.002). There was an effect modification of PAD on the association between MA and the DSST score. Amongst participants with PAD, the DSST score for those with MA was lower than those without MA (beta = -6.3, P = 0.003) after multivariate adjustment. Moreover, participants with PAD in the highest quartile of UACR had significantly lower DSST score compared to those in the lowest quartile (beta = -8.7, P = 0.001). There was no association between MA and cognitive function amongst participants without PAD. We observed an additive effect of MA and PAD on DSST score. Participants with both MA and PAD had a lower mean DSST score compared to those without both conditions (beta = -6.2, P = 0.003).Conclusions. The presence of MA or a higher level of urinary albumin excretion was inversely associated with cognitive function in participants with PAD.