Microalbuminuria Predicts Risk of Venous Thromboembolism

By Kathryn DeMott

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Patients with microalbuminuria may be at increased risk of developing venous thromboemboli, even in the absence of other risk factors, according to an analysis of data from a large community-based prospective cohort study.

About 7.2% of the general population is estimated to have microalbuminuria, which is treatable with nonanticoagulant medication. Further studies are needed to evaluate the effects of treating microalbuminuria on venous thromboembolism (VTE) risk, wrote Bakhtawar K. Mahmoodi, B.Sc., of the department of hematology at the University Medical Centre, Groningen, the Netherlands, and colleagues.

Venous thromboembolism occurs in developed countries at a rate of 0.15% a year, and in as many as half the cases none of the known risk factors are present.

For the study, 85,421 questionnaires were mailed to participants in the Prevention of Renal and Vascular End-stage Disease (PREVEND) study, which was designed to “investigate prospectively the natural course of albuminuria and its relation to renal and cardiovascular disease in a large cohort drawn from the general population” (JAMA 2009;301:1790-7).

From that total, 8,592 people, with a mean age of 49 years, completed a baseline screening protocol, and of those, 6,000 were found to have urinary albumin concentrations of 10 mg/L or greater and 2,592 had concentrations of less than 10 mg/L. Of these, 18 people were excluded because of missing data.

Overall, 129 people developed at least one VTE during a mean follow-up period of 8.6 years. Based on urinary albumin excretion (UAE) rates, annual VTE incidences were 0.40% in microalbuminuric participants (defined as those with UAEs of 30-300 mg/24 hr urine collection), compared with a 0.12% incidence in normoalbuminuric participants (UAEs of less than 30 mg/24 hr urine collection).

In a univariate analysis, adjusting for age and sex, only UAE, body mass index, premenopausal use of oral contraceptives, and plasminogen activator inhibitor type-1 levels were related to VTE; in a multivariate analysis, UAE remained “an independent predictor of VTE.”

The study results on risk factors for atherosclerosis “are consistent with a community-based, prospective cohort study” that showed that only [body mass index] and diabetes were related to VTE, after adjustments were made for race, sex, and age. In this study, diabetes and VTE are unrelated, and these study results do not apply to diabetic patients because of the exclusion of patients with insulin-dependent diabetes.

Compared with normoalbuminuria, microalbuminuria conferred an adjusted hazard ratio of 2.00 for VTE.

The investigators reported having no financial conflicts of interest to disclose.

Contact the Editor at vascularspecialist@vascularsociety.org.

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