Sex difference in the risk for exercise-induced albuminuria correlates with hemoglobin A1C and abnormal exercise ECG test findings

作者：Brzezinski Rafael Y; Etz Hadar Inbal; Grupper Ayelet; Ehrenwald Michal; Shapira Itzhak; Zeltser David; Berliner Shlomo; Rogowski Ori; Eldor Roy; Shenhar Tsarfaty Shani^*

来源：Cardiovascular Diabetology, 2017, 16(1): 79.

DOI：10.1186/s12933-017-0560-4

• Albuminuria
• Exercise
• Stress test
• Sex difference
• Gender
• HbA1c
• Microvascular
• Women-heart disease
• Risk scores

Background: Albuminuria is an established marker for endothelial dysfunction and cardiovascular risk in diabetes and prediabetes. Exercise induced albuminuria (EiA) appears earlier and may be a more sensitive biomarker for renal endothelial damage. We sought to examine the association between EiA, parameters of the metabolic syndrome, A1C levels, exercise ECG test results and sex related differences in a large cohort of healthy, pre-diabetic and diabetic subjects.
Methods: A total of 3029 participants from the Tel-Aviv Medical Center Inflammation Survey cohort (mean age 46 years, 73% men) were analyzed. Multiple physiologic and metabolic parameters including A1C were collected and albuminuria was measured in all subjects before and immediately after completing an exercise ECG test.
Results: Exercise increased urinary albumin to creatinine ratio (Delta EiA) by 2.8 (0-13.6) mg/g for median (IQR) compared to rest albuminuria (p < 0.001). An increase in Delta EiA was observed with accumulating parameters of the metabolic syndrome. Delta EiA showed significant interaction with sex and A1C levels; i.e. women with A1C > 6.5% had an increased risk of higher Delta EiA (p < 0.001). Using a cutoff of.EiA > 13 mg/g (top quartile) we found that women with Delta EiA > 13 mg/g were at greater risk for abnormal exercise ECG findings, (OR = 2.7, p = 0.001).
Conclusion: Exercise promotes excessive urinary albumin excretion in dysmetabolic patients. In women, a significant correlation exists between Delta EiA and A1C levels. A cutoff of Delta EiA > 13 mg/g in women may be used to identify populations at risk for abnormal exercise ECG test findings and perhaps increased cardiovascular risk. Future studies will be needed to further validate the usefulness of Delta EiA as a biomarker for cardiovascular risk in women with and without diabetes.

• 出版日期2017-6-23