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(Arteriosclerosis, Thrombosis, and Vascular Biology. 1995;15:1330-1337.)
© 1995 American Heart Association, Inc.

Articles

Longitudinal Study of Associations of Microalbuminuria With the Insulin Resistance Syndrome and Sodium-Lithium Countertransport in Nondiabetic Subjects

Wendy-Jane Foyle; Elin Carstensen; Maryam C. Fernández; John S. Yudkin

From the Department of Medicine, University College London Medical School, London, England.

Abstract Microalbuminuria in diabetic patients is associated with ischemic heart disease and insulin resistance. We previously found a 9% prevalence of microalbuminuria in a nondiabetic population that we have reassessed, investigating associations of microalbuminuria with hypertension, dyslipidemia, hyperinsulinemia, and sodium-lithium countertransport. Of 125 subjects reexamined, 42 had been microalbuminuric 3 years previously. Twelve of these (29%) were microalbuminuric on at least one sample at follow-up, and 30 (76%) were normoalbuminuric on two. Of the 79 previously normoalbuminuric subjects, 12 (15%) became microalbuminuric on one sample, while 67 (85%) remained normoalbuminuric. Subjects who were microalbuminuric at both screening and recall were older (mean±SD, 65.9±11 versus 59.1±10.2 years, P=.04), with a higher waist-to-hip ratio (0.93±0.09 versus 0.86±0.08, P=.008) and at recall, on univariate analysis, had higher specific insulin (44.2 [range, 16.9 to 157.0] versus 28.4 [7.4 to 129.0] pmol/L, P=.005), intact proinsulin (5.1 [1.5 to 11.0] versus 3.0 [0.8 to 14.6] pmol/L, P=.003), and des-31,32-proinsulin (5.0 [0.5 to 9.8] versus 1.0 [0.5 to 12.2] pmol/L, P=.004) concentrations. There was also a significant difference in des-31,32-proinsulin concentration, after adjustment for covariates (P=.013), between subjects classified either as microalbuminuric or as normoalbuminuric at screening. There was no difference in body mass index; fasting blood glucose; systolic or diastolic blood pressure; total, HDL, or LDL cholesterol; triglycerides; plasminogen activator inhibitor-1; or sodium-lithium countertransport activity between consistently normoalbuminuric and persistently microalbuminuric subjects. We found a positive relationship of changes in albumin excretion rate with those in HDL cholesterol concentrations over the follow-up period (r=.25, P=.009) but none with changes in fasting blood glucose, blood pressure, other lipids, insulin, or proinsulin-like molecules. In conclusion, microalbuminuria is an unstable phenomenon over a period of 3 years in nondiabetic subjects, with a coefficient of variation of 60% on two paired samples over this time. It is associated with increased concentrations of insulin and of proinsulin-like molecules but not with other features of the insulin resistance syndrome.

Key Words: microalbuminuria • insulin resistance • proinsulin-like molecules • plasminogen activator inhibitor-1 • sodium-lithium countertransport

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