Mercedes R. Carnethon

Association between Microalbuminuria and the Metabolic Syndrome: NHANES III

We investigated whether microalbuminuria was associated with the metabolic syndrome by comparing the strength of the association between microalbuminuria and the syndrome as a whole and its individual components. This investigation included 5659 women and men aged 20 to 80 years from the cross-sectional, nationally representative, Third National Health and Nutrition Examination Survey (NHANES III: 1988-1994). Metabolic syndrome was defined as any three of the following: increased waist circumference, increased triglycerides, decreased HDL cholesterol, increased blood pressure, or high fasting glucose. Microalbuminuria was defined as urinary albumin/creatinine ratio of 30 to 300 mg/g. Microalbuminuria was present in 7.8% of women and 5.0% of men. Log linear analysis revealed a significant association between the metabolic syndrome and microalbuminuria in both genders (women chi(2) = 44.1; men chi(2) = 59.6; P <.0001 for both). Microalbuminuria was more common in both women (odds ratio [OR] = 2.2; 95% confidence interval [CI] 1.44, 3.34) and men (OR = 4.1; 95% CI 2.45, 6.74) with metabolic syndrome compared to those without it; 34% of women and 42% of men with microalbuminuria also had metabolic syndrome. After adjusting for other components of the metabolic syndrome, hypertension demonstrated the strongest association with microalbuminuria in both women (OR = 3.34; 95% CI 2.45, 4.55) and men (OR = 2.51; 95% CI 1.63, 3.86). Microalbuminuria and metabolic syndrome are associated in a large, nationally representative cohort, possibly due to early renal effects of hypertension, and it may be useful to consider microalbuminuria as a component of the metabolic syndrome.

Prospective association between hormone replacement therapy, heart rate, and heart rate variability: The Atherosclerosis risk in communities study

Hormone replacement therapy is universally associated with coronary heart disease (CHD) in observational studies, but it is unknown whether this association is mediated by the autonomic nervous system. We tested the hypothesis that postmenopausal hormone replacement therapy was associated with more favorable heart rate (HR) and heart rate variability (HRV) in a population sample of women (n=2,621). Hormone therapy use was measured at four examinations beginning in 1987. Supine HR and HRV indices were measured for 6 minutes at the final examination (1996-1998). In unadjusted linear regression models, hormone therapy was associated with lower HR (hormone use=64.7 vs. never=65.7 beats/min, P=.01) and higher HRV. However, following adjustment for age and CHD risk factors, both associations were eliminated. Results from this observational study suggest that hormone therapy is not associated with HR or HRV. These analyses should be replicated in a randomized trial.