Albuminuria is a marker for endothelial dysfunction and knowledge on its association
with stroke and stroke subtypes are limited.Corresponding data from 7261 participants
of the population-based HUNT2 study (1995-1997) was linked with hospital records,
identified all patients registered and diagnosed with a first-time stroke. Each diagnosis
was validated by reviewal of the medical record appertaining to the individual. We
then applied Cox proportional hazard models to estimate the hazard ratios (HRs) for
the association between albuminuria (measured as albumin-to-creatinine-ratio, ACR)
and diagnosis of stroke and stroke subtypes.703 (9.7%) participants developed a first
ischemic stroke during a median follow-up of 15 years. Higher albuminuria was associated
with a higher rate for ischemic stroke and the risk rose steadily with increasing
ACR (15% increment per unit increase in ACR concentration in mg/mmol). In the fully
adjusted model, the HR for all ischemic strokes was 1.56 (95% CI 1.24-1.95) for those
with an ACR ≥3 mg/mmol compared to participants with an ACR < 1 mg/mmol. Overall,
increasing ACR was associated with a higher risk of all ischemic stroke subtypes.
This was seen to be strongest for lacunar stroke (HR 1.75, CI 1.12-2.72, p = 0.019),
and also for stroke of undetermined etiology (HR 1.53, CI 1.11-2.11, p = 0.009) and
those caused by atherosclerosis in the large arteries (HR 1.51, CI 0.78-2.94, p =
0.186) than for cardio-embolic stroke (HR 1.22, CI 0.64-2.3, p = 0.518).Albuminuria
is an important risk factor, potentially already at low grade, for ischemic stroke
especially for lacunar subtype. Measuring albuminuria is both cheap and readily available.
This offers the opportunity to evaluate the risk for endothelial dysfunction and thus
the subsequent risk for stroke and cerebral small vessel disease.
