In her PhD thesis, Gudrun Hatlén has investigated if including more than one urine sample of protein levels improves risk prediction for cardiovascular disease, and if there are any gender differences.


  1. Multiple urine sampling does not improve the ability of albuminuria to predict cardiovacular death.
  2. There are no significant gender differences in the association between albuminuria and coronary events.
  3. Both increasing and decreasing albuminuria are significant independent predictors of mortality.


Thesis: Low-grade albuminuria and its implementation in cardiovascular risk assessment. Analyses from the Nord-Trøndelag Health Studies; HUNT-2 and HUNT-3
Candidate: Gudrun Hatlén
Time: December 8, 2017 at 12:15
Place: Medical Technical Research Centre, St. Olavs Hospital: Auditorium MTA
Link to university website (in Norwegian)


Increased levels of protein in urine is called albuminuria, and reflects general damage of the blood vessels in the heart and kidneys. The association between albuminuria and coronary heart disease is well-known.

(1) The levels of protein in urine can vary significantly on a day-to-day basis. However, Hatlén and collegues found that using repeated urine sampling in the analysis did not improve risk prediction for cardiovascular death over using just a single sample. Including more urine samples was however useful in subjects with a low albumin-creatinine ratio.

More than 9000 participants from the HUNT Study were included and followed for 13 years. Cardiovascular risk was assessed by adding albumin-creatinine ratio to models based on Framingham variables.

(2) The significant assocation between albumin-creatinine ratio and risk of myocardial infarction within 14 years was similar in women and men. In women two or three urine samples were needed to confirm mild albuminuria and assess cardiovascular risk, whereas one sample was enough in men.

(3) By use of urine sampling from both the second and third wave of the HUNT study, Hatlén and co-workers looked at how changes in albumin-creatinine ratio over time affects mortality. Higher age, higher albumin-creatinine ratio at baseline, high blood pressure, smoking and reduced kidney function were associated with an increased albumin-creatinine ratio. Participants with the highest increase between HUNT2 and HUNT3 had 30 % higher mortality risk during eight years of follow-up, compared to participants with stable albumin-creatinine ratio. Participants who reduced their albumin-creatinine ratio over time also had increased risk.


(1) Hatlen, G., Romundstad, S., & Hallan, S. I. (2014). The accuracy of predicting cardiovascular death based on one compared to several albuminuria valuesKidney international85(6), 1421-1428.

(2) Hatlen, G., Romundstad, S., Salvesen, Ø., Dalen, H., & Hallan, S. I. (2016). Influence of Gender and Repeated Urine Sampling on the Association of Albuminuria with Coronary EventsNephron133(1), 44-52.

(3) Romundstad, S., Hatlen, G., & Hallan, S. I. (2016). Long-term changes in albuminuria: underlying causes and future mortality risk in a 20-year prospective cohort: the Nord-Trøndelag Health (HUNT) StudyJournal of hypertension34(10), 2081-2089.

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