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Urine albumin/creatinine ratio below 30mg/g is a predictor of incident hypertension and cardiovascular mortality

Urine albumin/creatinine ratio below 30mg/g is a predictor of incident hypertension and cardiovascular mortality
Urine albumin/creatinine ratio below 30mg/g is a predictor of incident hypertension and cardiovascular mortality
Background

Microalbuminuria is associated with cardiovascular disease (CVD) mortality, but whether lower levels of urine albumin excretion similarly predict CVD is uncertain. We investigated associations between urine albumin:creatinine ratio (UACR) <30 mg/g, and incident hypertension, incident diabetes mellitus, and all?cause and CVD mortality, during a maximum of 11 years of follow?up.

Methods and Results

Individuals (37 091) in a health screening program between 2002 and 2012 with baseline measurements of UACR were studied. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for incident hypertension, incident diabetes mellitus, and mortality outcomes (lowest UACR quartile as reference) at follow?up. For linear risk trends, the quartile rank was used as a continuous variable in regression models. Nine?hundred sixty?three cases of incident hypertension, 511 cases of incident diabetes mellitus, and 349 deaths occurred during follow?up. In the fully adjusted models, there was a significant HR for the association between UACR and incident hypertension (highest UACR quartile HR 1.95 [95% CI 1.51, 2.53], P?value for trend across UACR quartiles P<0.001). In contrast, the association between UACR and incident diabetes mellitus was not significant (highest UACR quartile, HR 1.15 [95% CI 0.79, 1.66], P?value for trend P=0.20). For CVD mortality, with increasing UACR quartiles, there was a significant increase in HR across quartiles, P=0.029, (for all?cause mortality, P=0.078).

Conclusions

Low levels of albuminuria, UACR below 30 mg/g, are associated with increased risk of incident hypertension and CVD mortality at follow?up, but are not associated with increased risk of incident diabetes mellitus.
albuminuria, low grade albuminuria, cardiovascular mortality, type 2 diabetes, hypertension
1-12
Sung, K.C.
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Ryu, S.
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Lee, J.Y.
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Lee, S.H.
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Cheong, E.S.
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Hyun, Y.Y.
b15b52f2-b01a-4fed-9e46-882df026d409
Lee, K.B.
ec003daa-ccb4-4061-8cee-61da376e4d42
Kim, H.
4f4342f7-daa3-4d3b-abcb-155f75a31824
Byrne, C.
1370b997-cead-4229-83a7-53301ed2a43c
Sung, K.C.
be77bd09-0bba-4fcf-8096-c0049ce4e2ce
Ryu, S.
c2eb4ab3-d9ea-49c4-846c-49afe538a376
Lee, J.Y.
06f3dfa6-5194-4015-a2b5-58e9376553dd
Lee, S.H.
104039b1-5d0a-4175-9a03-55a52132be2b
Cheong, E.S.
e19be807-d661-4b0e-97cf-243d7c75efc1
Hyun, Y.Y.
b15b52f2-b01a-4fed-9e46-882df026d409
Lee, K.B.
ec003daa-ccb4-4061-8cee-61da376e4d42
Kim, H.
4f4342f7-daa3-4d3b-abcb-155f75a31824
Byrne, C.
1370b997-cead-4229-83a7-53301ed2a43c

Sung, K.C., Ryu, S., Lee, J.Y., Lee, S.H., Cheong, E.S., Hyun, Y.Y., Lee, K.B., Kim, H. and Byrne, C. (2016) Urine albumin/creatinine ratio below 30mg/g is a predictor of incident hypertension and cardiovascular mortality. Journal of the American Heart Association, 5 (9), 1-12. (doi:10.1161/JAHA.116.003245). (PMID:27625343)

Record type: Article

Abstract

Background

Microalbuminuria is associated with cardiovascular disease (CVD) mortality, but whether lower levels of urine albumin excretion similarly predict CVD is uncertain. We investigated associations between urine albumin:creatinine ratio (UACR) <30 mg/g, and incident hypertension, incident diabetes mellitus, and all?cause and CVD mortality, during a maximum of 11 years of follow?up.

Methods and Results

Individuals (37 091) in a health screening program between 2002 and 2012 with baseline measurements of UACR were studied. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% CIs for incident hypertension, incident diabetes mellitus, and mortality outcomes (lowest UACR quartile as reference) at follow?up. For linear risk trends, the quartile rank was used as a continuous variable in regression models. Nine?hundred sixty?three cases of incident hypertension, 511 cases of incident diabetes mellitus, and 349 deaths occurred during follow?up. In the fully adjusted models, there was a significant HR for the association between UACR and incident hypertension (highest UACR quartile HR 1.95 [95% CI 1.51, 2.53], P?value for trend across UACR quartiles P<0.001). In contrast, the association between UACR and incident diabetes mellitus was not significant (highest UACR quartile, HR 1.15 [95% CI 0.79, 1.66], P?value for trend P=0.20). For CVD mortality, with increasing UACR quartiles, there was a significant increase in HR across quartiles, P=0.029, (for all?cause mortality, P=0.078).

Conclusions

Low levels of albuminuria, UACR below 30 mg/g, are associated with increased risk of incident hypertension and CVD mortality at follow?up, but are not associated with increased risk of incident diabetes mellitus.

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__soton.ac.uk_UDE_PersonalFiles_Users_lce_mydocuments_Eprints - Prof Byrne_Accepted pubs for Eprints_JAHA_Sung K-Byrne CD_Aug 2016_249304_2_merged_1469775545.pdf - Accepted Manuscript
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More information

Accepted/In Press date: 5 August 2016
e-pub ahead of print date: 13 September 2016
Keywords: albuminuria, low grade albuminuria, cardiovascular mortality, type 2 diabetes, hypertension
Organisations: Human Development & Health

Identifiers

Local EPrints ID: 399205
URI: http://eprints.soton.ac.uk/id/eprint/399205
PURE UUID: 812e6129-22b0-474b-8671-00be2ad946fa
ORCID for C. Byrne: ORCID iD orcid.org/0000-0001-6322-7753

Catalogue record

Date deposited: 09 Aug 2016 13:53
Last modified: 07 Oct 2020 04:57

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