Abstract
OBJECTIVES: To investigate the correlation between the urinary albumin-to-creatinine ratio (UACR) and adverse cardiovascular outcomes in the Beijing community population. DESIGN: Prospective cohort study. SETTING: Beijing, China, from May 2014 to December 2021. PARTICIPANTS: Recruited from a survey conducted as part of an ongoing atherosclerosis cohort study in the communities of Gucheng and Pingguoyuan, Shijingshan District in Beijing, China. Excluded participants who already had a history of stroke or myocardial infarction at baseline. Finally, 3627 eligible participants were included in this analysis. EXPOSURE: The participants were divided into three groups on the basis of baseline UACR: the normal group (UACR<30 mg/g), the microalbuminuria group (30 mg/g≤UACR<300 mg/g) and the dominant proteinuria group (UACR≥300 mg/g). PRIMARY AND SECONDARY OUTCOME MEASURES: The primary endpoint was a composite endpoint (major adverse cardiovascular event, MACE) of cardiovascular death, first acute myocardial infarction or first stroke, whereas secondary endpoints included cardiovascular death, first acute myocardial infarction, first stroke or all-cause death. RESULTS: The study included 3627 participants. According to the multivariable Cox model, compared with those in the normal group, the risks of MACE (HR=1.47; 95% CI 1.06 to 2.06; p=0.023), cardiovascular death (HR=3.03; 95% CI 1.56 to 5.88; p=0.001) and all-cause mortality (HR=1.91; 95% CI 1.23 to 2.97; p=0.004) were significantly greater in the microalbuminuria group. The risk of MACE (HR=3.65; 95% CI 2.14 to 6.23; p<0.001), cardiovascular death (HR=7.91; 95% CI 2.92 to 21.43; p<0.001), stroke (HR=2.57; 95% CI 1.30 to 5.08; p=0.007) and all-cause death (HR=3.59; 95% CI 1.63 to 7.89; p=0.001) in the group with dominant proteinuria was significantly greater than that in the normal group. The absolute risk differences (per 1000 person-years) for MACE were 14.86 (95% CI 7.20 to 22.51) in the microalbuminuria group and 64.85 (95% CI 26.76 to 102.94) in the dominant proteinuria group, compared with the normal group (incidence rates: 25.24 and 75.23 vs 10.38, respectively). In populations with a UACR less than 30 mg/g, there was a significant increase in the risk of MACE as the UACR increased (HR=1.02; 95% CI 1.00 to 1.04; p=0.036). CONCLUSIONS: This study indicates that an elevated UACR is a significant risk factor for adverse cardiovascular outcomes within the community population. This association remains consistent in individuals with low-grade albuminuria.