Aortic valve sclerosis and albuminuria predict cardiovascular events independently in hypertension : A losartan intervention for endpoint-reduction in hypertension (LIFE) substudy

• Published in: American journal of hypertension 2005-11, Vol.18 (11), p.1430-1436
• Main Authors: OLSEN, Michael H, WACHTELL, Kristian, BELLA, Jonathan N, PALMIERI, Vittorio, GERDTS, Eva, SMITH, Gunnar, NIEMINEN, Markku S, DAHLÖF, Björn, IBSEN, Hans, DEVEREUX, Richard B
• Format: Article
• Language: English
• Subjects: Aged; Albuminuria - urine; Antihypertensive Agents - therapeutic use; Aortic Valve - pathology; Arterial hypertension. Arterial hypotension; Atenolol - therapeutic use; Biological and medical sciences; Blood and lymphatic vessels; Cardiology. Vascular system; Cardiovascular Diseases - etiology; Cardiovascular Diseases - pathology; Cardiovascular Diseases/etiology/pathology; Clinical manifestations. Epidemiology. Investigative techniques. Etiology; Double-Blind Method; Electrocardiography; Follow-Up Studies; Fundamental and applied biological sciences. Psychology; Hemodynamics. Rheology; Humans; Hypertension - complications; Hypertension - drug therapy; Hypertension - urine; Hypertension/complications/drug therapy/urine; Hypertrophy; Hypertrophy, Left Ventricular - complications; Hypertrophy, Left Ventricular - diagnosis; Left Ventricular/complications/diagnosis; Losartan - therapeutic use; MEDICAL AND HEALTH SCIENCES; Medical sciences; MEDICIN OCH HÄLSOVETENSKAP; Middle Aged; Predictive Value of Tests; Prognosis; Risk Factors; Sclerosis; Survival Analysis; Treatment Outcome; Vertebrates: cardiovascular system
• ISSN: 0895-7061; 1879-1905
• DOI: 10.1016/j.amjhyper.2005.05.030

Aortic valve (AV) sclerosis and urine albumin/creatinine ratio (UACR) are both markers of atherosclerosis. We aimed to investigate whether they predicted cardiovascular (CV) events independently in patients with hypertension and electrocardiographic left ventricular (LV) hypertrophy. After 2 weeks of placebo treatment, clinical, laboratory, and echocardiographic variables were assessed in 960 hypertensive patients from the LIFE Echo substudy who had electrocardiographic LV hypertrophy. Morning urine albumin and creatinine were measured calculating UACR. The presence of AV sclerosis was defined as valve thickening or calcification. Fifteen patients with mild AV stenosis were excluded. The patients were followed for 60 +/- 4 months and the composite endpoint (CEP) of CV death, nonfatal stroke, or nonfatal myocardial infarction was recorded. A value of UACR above the median value of 1.406 was associated with higher incidence of CEP and CV death in patients with AV sclerosis (CEP: 18.8% v 9.0% P < 0.05, CV death: 7.1% v 0.7% P < 0.01) and in patients without AV sclerosis (CEP: 14.0% v 4.9% P < 0.001, CV death: 5.1% v 1.1% P < 0.01). In Cox regression analysis, AV sclerosis predicted CEP (hazard ratio [HR] = 1.52, P < .05), but not CV death (HR = 1.30 [0.62 to 2.70], NS) independently of logUACR (HR = 1.70 and HR = 3.25, both P < .001). After adjusting for the Framingham Risk Score, CV disease, diabetes, smoking, and treatment allocation, AV sclerosis predicted CEP (HR = 1.5, P < .05) but not CV death (HR = 1.4, NS) independently of logUACR (HR = 1.2, P = .09 and HR = 1.94, P < .05). In hypertensive patients with electrocardiographic LV hypertrophy, AV sclerosis predicted CEP but not CV death independently of UACR after adjusting for CV risk factors and treatment allocation, indicating that AV sclerosis and UACR might be markers of different aspects of the atherosclerotic process.