Association between urinary albumin creatinine ratio and cardiovascular disease

Abstract

Introduction: The association between microalbuminuria and cardiovascular disease (CVD) is accumulating in various patient populations. However, when stratified by sex, the relationship between microalbuminuria and CVD remains unclear.

Method: We obtained data from the 2011-2014 and 2019-2020 Korea National Health and Nutrition Examination Survey (KNHANES). Microalbuminuria was measured based on spot urine albumin-creatinine ratio (UACR). The Framingham risk score (FRS) model was implemented to evaluate the CVD risk. Linear and logistic regression models were used to identify the associations of microalbuminuria status with cardiometabolic predictors and CVD status determined by the FRS score.

Results: Among 19,340 representative Korean participants, the (UACR) in Korean women and men with history of CVD was higher than in those without history of CVD. Among patients without history of CVD, multivariate regression analysis showed that a high UACR was related to older age, lower high-density lipoprotein cholesterol level, higher total cholesterol level, higher systolic blood pressure, higher prevalence of current smoking, higher prevalence of diabetes, and higher anti-hypertensive medication use in both women and men. The UACR showed a positive linear correlation with the Framingham risk score in both women and men.

Conclusion: The presence of microalbuminuria was significantly associated with the cardiometabolic risk factors and the increased risk of CVD evaluated by FRS model in both women and men in a nationally representative sample of Korea.

Fig 1

UACRs according to CVD status in Korean women (A) and men (B). Left side boxplots (grey and brown colored boxes) indicate median-based summary statistics; specifically, the middle, upper, and lower lines describe median, 75, and 25 percentile values, respectively. Right side boxplots indicate mean-based summary statistics, in which the middle, upper, and lower lines illustrate mean, one standard deviation values, respectively.

Fig 2

Relationship between UACR and cardiometabolic risk factors in Korean women (A) and men (B). Beta values were measured by linear regression after setting continuous variables, including age, TC, HDL-C, and SBP as dependent variables and UACR subgroups as independent variables. In case of features exhibiting binomial distribution, such as AHM use, smoking, and diabetes, the ratio of presence of disease or status was set as the dependent variable in the linear regression for the calculation of the Beta value. Abbreviations: UACR, urinary albumin-creatinine ratio; Beta, beta-coefficient; AHM, anti-hypertensive medication; HDL-C. high-density lipoprotein-cholesterol; SBP, systolic blood pressure; TC, total cholesterol.

Fig 3

Relationship between albuminuria and cardiometabolic risk factors in Korean women (A) and men (B). Top four graphs (i.e., age, TC, HDL-C, SBP) were obtained by multivariate linear regression after setting the four predictors arranged separately as dependent variables. UACR was determined as the independent variable, and other remnant six predictors as covariates. The lower three graphs (i.e., AHM, smoking, diabetes) were obtained by multivariate logistic regression set to the same conditions as the multivariate linear regression. All x-axes indicate beta-coefficients obtained from the multivariate linear or logistic regressions. UACR levels were log-transformed for the associational analyses. Abbreviations: TC, total cholesterol; HDL-C, high-density lipoprotein cholesterol; SBP, systolic blood pressure; HTN Med, hypertension medication; DM, diabetes mellitus.

Fig 4

Relationship between albuminuria and FRS in Korean women (A) and men (B). Urine albumin-to-creatine ratio was categorized into 20 groups (x-axes) based on ascending order. FRS was calculated based on the equation provided by a study [22]. Abbreviation: FRS, Framingham risk score.