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. 2025 Apr 11:16:1456731.
doi: 10.3389/fendo.2025.1456731. eCollection 2025.

The relationship between blood urea nitrogen to serum albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in patients with diabetes mellitus

Hongwei Zhu #  1 , Wei Xie #  2 , Peng Wang  3 , ShuYuan Jiang  2 , YunQi Hua  4 , Guo Shao  5 , ZhiHui Li  6
Affiliations

The relationship between blood urea nitrogen to serum albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in patients with diabetes mellitus

Hongwei Zhu et al. Front Endocrinol (Lausanne). .

Abstract

Background: The relationship between the Blood Urea Nitrogen to Albumin Ratio (BAR) and cardiovascular diseases in diabetes, as well as cardiovascular and all-cause mortality, is not yet entirely understood. This study aimed to examine the correlation between the serum urea nitrogen to albumin ratio and cardiovascular diseases, cardiovascular mortality, and all-cause mortality in diabetes.

Methods: A total of 7043 adult diabetes patients were included from the NHANES database from 2001 to 2018. The relationship between BAR and cardiovascular diseases, cardiovascular mortality and all-cause mortality in patients with diabetes mellitus was verified using baseline characteristic analysis, multivariate logistic regression analysis, multivariate Cox proportional hazards model, Kaplan-Meier (K-M) analysis, smoothed fitted curves, and subgroup analysis.

Results: Results of the logistic regression analysis indicated a substantial positive association, between the BAR and the risk of cardiovascular disease in individuals with diabetes (HR, 1.09 [95% CI 1.06-1.12], p < 0.001). Cox regression analysis revealed a substantial positive association between the BAR and the risk of cardiovascular (OR, 1.13 [95% CI, 1.10-1.17], p < 0.001) and all-cause mortality (OR, 1.12 [95% CI 1.11-1.14], p < 0.001) in diabetes. The restricted cubic spline (RCS) curves indicated a non-linear relationship between BAR and the risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes (p < 0.01). The receiver operating characteristic (ROC) curves demonstrated that the BAR had superior predictive performance for cardiovascular risk (AUC: 0.648), cardiovascular mortality (AUC: 0.618), and all-cause mortality (AUC: 0.674) compared to the body mass index (BMI) (cardiovascular risk AUC: 0.525, cardiovascular mortality AUC: 0.563, all-cause mortality AUC: 0.571) and the weight-adjusted-waist index (WWI) (cardiovascular risk AUC: 0.579, cardiovascular mortality AUC: 0.497, all-cause mortality AUC: 0.570). These results underscore the enhanced ability of the BAR to discriminate between positive and negative outcomes, making it a more effective predictor than WWI. Kaplan-Meier analysis further verified the predictive capacity of BAR, for cardiovascular mortality and all-cause mortality in diabetes patients. Subgroup analysis revealed consistent associations between BAR and a variety of subgroups.

Conclusion: The incidence of cardiovascular disease, cardiovascular mortality, and all-cause mortality was substantially elevated, in patients with diabetes with a higher BAR level. Cardiovascular disease, cardiovascular mortality, and all-cause mortality may be more prevalent among diabetic patients with elevated BAR levels. BAR is a novel marker for the prediction of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes.

Keywords: all-cause mortality; blood urea nitrogen to serum albumin ratio; cardiovascular disease; cardiovascular mortality; diabetes mellitus.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
Research flow chart. Flow chart of the sample selection process.
Figure 2
Figure 2
RCS curves for BAR and the risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes. —associations between BAR with cardiovascular diseases (A), congestive heart failure (B), coronary heart disease (C), Angina (D), Heart attack (E), Stroke (F), cardiovascular mortality (G) and all-cause mortality (H) among participants with diabetes in NHANES 2001–2018.
Figure 3
Figure 3
ROC curve analysis of the predictive value of BAR ratio for the risk of cardiovascular disease (A), cardiovascular mortality (B), and all-cause mortality (C) in diabetes.
Figure 4
Figure 4
Kaplan-Meier survival curves for cardiovascular mortality (A) and all-cause mortality (B) by BAR tertile groups figure.
Figure 5
Figure 5
Forest plot for the association between BAR ratio and the risk of cardiovascular disease, cardiovascular mortality, and all-cause mortality in diabetes.
See this image and copyright information in PMC

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