In addition, elevated urinary albumin excretion rate, as a marker of systemic microcirculatory dysfunction, predicts both incident stroke [73] and survival after stroke [59]. Recently, an elevated urinary albumin excretion rate has been associated with elevated capillary pressure [50] and impaired microcirculatory autoregulation [54]. This abnormality in autoregulation also predicts adverse left ventricular Selleck GS 1101 remodeling and left atrial size, both predictors of future stroke and

cardiovascular mortality (Figure 1) [55]. Indeed, this autoregulatory abnormality explains the association between left ventricular hypertrophy and albumin excretion rate, and may represent an etiopathogenic link. It is currently under further investigation. Most cardiovascular disease occurs in the proportionately larger number of individuals with low-to-moderate absolute risk. Clinical intervention decisions are often based on the likelihood Ensartinib that an individual will have a cardiovascular event over a given period of time; however, these decisions are often made on an incomplete assessment of risk. These epidemiological studies have demonstrated the importance of microcirculatory dysfunction as an early marker of vascular disease, prior to established markers, such as elevated glucose, hypertension or left ventricular hypertrophy being present. Screening for

microvascular dysfunction using a combination of the aforementioned techniques can be advantageous for the early detection of microvascular disease, in aiding diagnosis, in monitoring disease progression, and response to therapy. Most of the techniques discussed herein are used in the exploration of microvascular function in a research setting. Only some of these may be easily translated into clinical practice. Investigating the retinal microvasculature is relatively simple and can be employed on a large scale [68]. As such, it has been translated into Amobarbital clinical practice for those

with diabetes at least. Similarly, urinary albumin excretion rate translates easily into clinical practice as its proxy, albumin:creatinine ratio, can be measured on a single urine specimen. Changes in urinary albumin excretion have been shown to be very useful for estimating risk of future CV events [18,31]. Therefore, this suggests that to reduce the risk for cardiovascular disease, progression of urinary albumin excretion should be prevented and regression thereof regarded as a primary treatment goal [9]. However, there are limited data on the long-term cost-effectiveness of systematic screening for urinary albumin excretion and more importantly, targeting it as a therapeutic outcome in those at high risk either by virtue of their hypertension or their past disease such as stroke, transient ischemic attack or myocardial infarction [4].