Journal
JOURNAL OF HYPERTENSION
Volume 36, Issue 5, Pages 1178-1187Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/HJH.0000000000001674
Keywords
albuminuria; cardiovascular disease; diabetes mellitus; endothelial dysfunction; endothelium; microalbuminuria; microcirculation
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Funding
- European Regional Development Fund via OP-Zuid
- Province of Limburg
- Dutch Ministry of Economic Affairs [31O.041]
- Stichting De Weijerhorst (Maastricht, the Netherlands)
- Pearl String Initiative Diabetes (Amsterdam, the Netherlands)
- Cardiovascular Center (CVC, Maastricht, the Netherlands)
- CARIM School for Cardiovascular Diseases (Maastricht, the Netherlands)
- CAPHRI School for Public Health and Primary Care (Maastricht, the Netherlands)
- NUTRIM School for Nutrition and Translational Research in Metabolism (Maastricht, the Netherlands)
- Stichting Annadal (Maastricht, the Netherlands)
- Health Foundation Limburg (Maastricht, the Netherlands)
- Janssen-Cilag B.V. (Tilburg, the Netherlands)
- Novo Nordisk Farma B.V. (Alphen aan den Rijn, the Netherlands)
- Sanofi-Aventis Netherlands B.V. (Gouda, the Netherlands)
- Fresenius Medical Care (Bad Homburg, Germany)
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Objective:Albuminuria is thought to be a biomarker of microvascular and macrovascular endothelial dysfunction. However, direct evidence for an association of microvascular endothelial dysfunction with albuminuria is limited. In addition, experimental data suggest a stronger association of microvascular endothelial dysfunction with albuminuria in individuals with than in those without diabetes.Methods:We examined cross-sectional associations of flicker light-induced retinal arteriolar dilation (n=2095) and heat-induced skin hyperemia (n=1508) with 24-h albuminuria in the population-based, diabetes-enriched Maastricht Study. We used linear regression analyses to adjust for age, sex, type 2 diabetes, and cardiovascular disease risk factors. In addition, we tested for statistical interaction with type 2 diabetes.Results:Median [interquartile range] albuminuria was 6.5 [3.9-11.6] mg/24h and 8.2% had albuminuria at least 30mg/24h. After adjustment, albuminuria was 1.168 (95% confidence interval, 1.046-1.303) times greater in participants in the quartile with the smallest flicker light-induced retinal arteriolar dilation relative to those with the greatest dilation, and this association was stronger in participants with type 2 diabetes (P-interaction<0.10). Further, each 100 percentage points lower heat-induced skin hyperemia was associated with a 1.022 (1.010-1.035) times greater albuminuria in participants with type 2 diabetes, whereas it was not associated with albuminuria in nondiabetic participants (P-interaction<0.10).Conclusion:This is the first population-based study that provides direct evidence that microvascular endothelial dysfunction is associated with albuminuria, and that this association is stronger in individuals with than in those without type 2 diabetes.
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