Elevated urinary albumin excretion complements the Framingham Risk Score for the prediction of cardiovascular risk — response to treatment in the PREVEND IT trial

Background

The PREVEND IT trial reported on a high cardiovascular (CV) event rate in subjects with a baseline urinary albumin excretion (UAE) rate of ≥ 50 mg/24 h. Here, we report on the observed 10-year CV outcome of this population and compare this with the predicted Framingham Risk Score (FRS). In addition, we evaluated the effect of four years of fosinopril treatment on this relation.

Methods and results

From the PREVEND IT cohort, 833 subjects without history of CV disease, randomized to fosinopril (N = 412) or placebo (N = 421), were studied. The primary endpoint included CV mortality and adjudicated hospitalization for CV disease during a 10-year follow-up period. Mean age was 51 ± 12 years and 65% were males, while prevalence of diabetes (2.6%) and use of CV drugs (3.5%) was low. Subjects were categorized to high UAE (≥ 50 mg/24 h) or low UAE (< 50 mg/24 h). After 10 years of follow-up, the event rate in the high UAE group was almost twice as high as predicted by the FRS (29.5% vs. 17.2%). Treatment for four years with fosinopril reduced the event rate to comparable levels of that predicted by FRS. The addition of UAE ≥ 50 mg/24 h to the FRS improved the Integrated Discrimination Improvement (P = 0.033) and increased the area under the curve by 0.54% (P = 0.024).

Conclusions

The 10-year CV risk of subjects with an elevated UAE (≥ 50 mg/24 h) is substantially underestimated by the FRS. Treatment with fosinopril successfully reduced this increased event rate to FRS-predicted CV risk.