Urinary albumin-to-creatinine ratio levels are associated with subclinical atherosclerosis and predict CVD events and all-cause deaths: a prospective analysis

Shanshan Liu; Jingya Niu; Shujing Wu; Zhuojun Xin; Zhiyun Zhao; Min Xu; Jieli Lu; Tiange Wang; Yuhong Chen; Shuangyuan Wang; Hong Lin; Yiping Xu; Lei Ye; Meng Dai; Weiqing Wang; Guang Ning; Yufang Bi; Yu Xu; Mian Li

doi:10.1136/bmjopen-2020-040890

Urinary albumin-to-creatinine ratio levels are associated with subclinical atherosclerosis and predict CVD events and all-cause deaths: a prospective analysis

BMJ Open. 2021 Mar 3;11(3):e040890. doi: 10.1136/bmjopen-2020-040890.

Authors

Shanshan Liu^#^{1

2}, Jingya Niu^#^{1

2}, Shujing Wu^#^{1

2}, Zhuojun Xin^{1

2}, Zhiyun Zhao^{1

2}, Min Xu^{1

2}, Jieli Lu^{1

2}, Tiange Wang^{1

2}, Yuhong Chen^{1

2}, Shuangyuan Wang^{1

2}, Hong Lin^{1

2}, Yiping Xu³, Lei Ye^{1

2}, Meng Dai^{1

2}, Weiqing Wang^{1

2}, Guang Ning^{1

2}, Yufang Bi^{4

2}, Yu Xu^{4

2}, Mian Li^{4

2}

Affiliations

¹ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
² Shanghai National Clinical Research Center for Metabolic Diseases, Key Laboratory for Endocrine and Metabolic Diseases of the National Health Commission of the PR China, Shanghai National Center for Translational Medicine, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
³ Clinical Trials Center, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China.
⁴ Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong University School of Medicine, Shanghai, China limian39@aliyun.com jane.yuxu@gmail.com byf10784@rjh.com.cn.

^# Contributed equally.

Abstract

Objective: We aimed to examine the associations of urinary albumin-to-creatinine ratio (ACR) levels with risks of subclinical atherosclerosis, cardiovascular events and all-cause deaths.

Methods: Data from a large population-based cohort were used, which included 9580 participants aged ≥40 years free from cardiovascular diseases. Carotid intima-media thickness, brachial-ankle pulse wave velocity and ankle-brachial index were measured at baseline to assess subclinical atherosclerosis. After a median of 4.53 years' follow-up, 486 cardiovascular events and 230 all-cause deaths were recorded.

Results: The urinary ACR levels were categorised into three groups. Compared with the normal group (0≤ACR <7.82 mg/g), people with low-grade albuminuria (7.82≤ACR <30 mg/g) and albuminuria (ACR ≥30 mg/g) had higher levels of subclinical atherosclerosis. In prospective analysis, people with low-grade albuminuria was not significantly associated with cardiovascular events (HR=1.18; 95% CI 0.95 to 1.46], whereas people with albuminuria had a 50% higher risk of cardiovascular events (HR=1.50; 95% CI 1.11 to 2.03). People with low-grade albuminuria and albuminuria had 43% (HR=1.43; 95% CI 1.05 to 1.93) and 87% (HR=1.87; 95% CI 1.24 to 2.81) higher risks of all-cause deaths during follow-up, respectively. In stratified analysis, the association of higher ACR with risks of cardiovascular events and all-cause deaths was stronger among individuals with concomitant subclinical atherosclerosis, the presence of diabetes and more cardiovascular risk factors, respectively.

Conclusions: ACR levels were positively associated with subclinical atherosclerosis and predicted the risks of cardiovascular events and all-cause deaths. Evaluation of ACR levels should be integrated into risk stratification and prevention of cardiovascular events and all-cause deaths, especially among those with pre-existing subclinical atherosclerosis and cardiometabolic abnormalities.

Keywords: cardiology; coronary heart disease; myocardial infarction.

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Adult
Albumins
Albuminuria
Ankle Brachial Index
Atherosclerosis*
Cardiovascular Diseases*
Carotid Intima-Media Thickness
Creatinine
Humans
Prospective Studies
Pulse Wave Analysis
Risk Factors

Substances

Albumins
Creatinine