Screening for albuminuria with subsequent screening for hypertension and hypercholesterolaemia identifies subjects in whom treatment is warranted to prevent cardiovascular events

Abstract

In the general population, many subjects have yet unrecognized hypertension and hypercholesterolaemia, and are thus not treated. We investigated whether population screening for elevated albuminuria can identify subjects with previously unrecognized hypertension and/or hypercholesterolaemia at high risk for cardiovascular (CV) disease. Included were 8143 subjects (28–75 years) that participate in the PREVEND study, a general population-based, observational cohort study. Elevated albuminuria was defined as an albumin concentration ≥20 mg/L in a first morning urine sample confirmed by an albumin excretion ≥30 mg/day in two 24-h urine samples. Hypertension was defined as SBP ≥140 mmHg or DBP ≥90 mmHg, and hypercholesterolaemia as serum total cholesterol ≥6.2 mmol/L, or as HDL cholesterol < 0.9 mmol/L and a total/HDL cholesterol ratio of ≥ 6. Combined CV morbidity and mortality during follow-up was adopted as outcome. In the group with, as well as in the group without elevated albuminuria, the number of subjects with yet unrecognized hypertension and hypercholesterolaemia was at least 2-fold higher than the number of subjects known with these CV risk factors. Mean follow-up was 7.1 ± 1.5 years, during which 445 CV events occurred. The hazard ratio for CV events was significantly elevated in the subjects with, compared with those without elevated albuminuria, independent of whether they had no CV risk factor present, a CV risk factor known or a CV risk factor newly discovered. The CV event rate in those with an elevated albuminuria crossed the recommended threshold to start antihypertensive or anticholesterolaemic treatment, not only when the CV risk factor was known, but also in the subgroup with newly diagnosed CV risk factor. In subjects with a newly discovered CV risk factor without albuminuria, absolute CV risk was significantly lower. Screening for elevated albuminuria and subsequent screening for CV risk factors identify subjects with yet unknown CV risk factors at high risk for CV disease that are likely to benefit from early preventive treatment.