Background: In the Losartan Intervention For Endpoint reduction in hypertensio n(LIFE) study, reduced urine albumin/ creatinine ratio(UACR) as well as regressi on of left ventricular hypertrophy have been associated with lower incidence of cardiovascular events. We wanted to investigate whether these prognostic improve ments were independent. Methods: In 6679 hypertensive patients included in the L IFE study,we measured UACR, left ventricular hypertrophy by electrocardiography, serum cholesterol, plasma glucose and blood pressure after 2 weeks of placebo t reatment and again after 1 year of anti-hypertensive treatment with either an a tenolol-or a losartan-based regimen. During this first year of treatment, 77 p atients encountered a non-fatal stroke or myocardial infarction and were exclud ed to avoid bias. During the next 3-4 years, 610 composite endpoints[cardiovasc ular death(n=228), fatal or non-fatal myocardial infarction or stroke] were rec orded. Results: In Cox regression analyses, the composite endpoint was after adj ustment for treatment allocation predicted by baseline logUACR[hazard ratio(HR)= 1.16 per 10-fold increase, P< 0.05], 1-year logUACR(HR=1.29 per 10-fold incre ase), baseline Sokolow-Lyon voltage(HR=1.01 per mm, both P< 0.001) and 1-year Cornell product(HR=1.01 per 100 mm x ms, P< 0.01). Cardiovascular death was pred icted by 1-year logUACR(HR=1.59, P< 0.001), baseline Sokolow-Lyon voltage(HR=1 .01, P=0.06) and 1-year Cornell product(HR=1.02, P< 0.001). Both were predicted independent of age, Framingham risk score, current smoking, history of cardiova scular disease and diabetes. Gender, serum cholesterol, plasma glucose and blood pressure did not enter the models. Conclusions: Baseline UACR and Sokolow-Lyon voltage, as well as in-treatment UACR and Cornell product, added to the risk p rediction independent of traditional risk factors, indicating that albuminuria a nd left ventricular hypertrophy reflect different aspects of cardiovascular dama ge and are modifiable cardiovascular risk factors.
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