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Urinary acr importance reinforced.

These findings from the REGARDS study highlight the complexities inherent in the relation between albuminuria and cardiovascular disease risk, and underscore the importance of urine ACR elevations, Dr. Daniel E. Weiner and Dr. Wolfgang C. Winkelmayer wrote in an editorial.

Key questions raised by the study are, why do black individuals have higher levels of albuminuria than white individuals, and what can be done to reduce associated cardiovascular disease risk in those at higher risk, they said.

The questions could be answered only in a setting of equal care access and use, and equally healthy living strategies beginning early in life, "such that genetic factors that may influence kidney disease can be distinguished from factors related to indolent chronic diseases (metabolic syndrome, hypertension, type 2 diabetes, and prediabetes)," they said, noting that such diseases are at least somewhat preventable with healthy living, are more common in black individuals and people of lower socioeconomic status, and are associated with cardiovascular disease and higher albuminuria (JAMA 2013;310:697-8).

"Until these complex relationships are better disentangled, the study by Dr. Gutierrez and colleagues reinforces that even mild elevations in urine ACR are associated with increased CVD risk, even though this level of albuminuria will have no meaningful systemic effects," they said, adding that differentiating between low normal (less than 10 mg/g) and high normal (10-30 mg/g) urinary ACR may help with cardiovascular risk stratification, particularly in black individuals, perhaps leading to preventive efforts and improved monitoring.

Dr. Weiner is with Tufts Medical Center, Boston. He reported having no disclosures. Dr. Winkelmayer is with Stanford (Calif) University. He reported having served as an adviser or consultant to Amgen and numerous other pharmaceutical and device manufacturers.
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Title Annotation:VIEW ON THE NEWS
Publication:Internal Medicine News
Date:Sep 15, 2013
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