PDF(Pubmed)
Abstract：
UNASSIGNED: Albuminuria is associated with cardiovascular events among adults with underlying cardiovascular disease and diabetes, even at low levels of urinary albumin excretion. We hypothesized that low levels of albuminuria in the \'normal\' range (urinary albumin-to-creatine ratio (UACR) <30 mg/g) are associated with cardiovascular death among apparently healthy adults.
UNASSIGNED: We studied adults who participated in the 1999-2014 National Health and Nutrition Examination Survey. We excluded participants with baseline cardiovascular disease, hypertension, diabetes, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, those who were currently pregnant, and those who had received dialysis in the last year. After excluding these conditions, only 5.0% of the remaining population had UACR ≥30 mg/g (N=873) and were excluded. The final sample size was 16,247. We assessed the relationship between UACR and cardiovascular and all-cause mortality using multivariable-adjusted Cox proportional hazards models. Models were adjusted for age, sex, race or ethnicity, smoking status, systolic blood pressure, hemoglobin A1c, total cholesterol, health insurance, food insecurity, serum albumin, body mass index, use of statins, and eGFR.
UNASSIGNED: Mean age was 38.9 years (SD 13.6) and 53.7% were women. The median length of follow-up was 12.2 years. In multivariable-adjusted models, each doubling of UACR (within the <30 mg/g range) was associated with a 36% higher risk of cardiovascular death [HR 1.36 (95% confidence interval (CI) 1.11-1.65)] and a 28% higher risk of all-cause mortality [HR 1.28 (95%CI 1.17-1.41)]. The highest tertile of UACR (7.1-29.9 mg/g) was associated with an 87% higher risk of cardiovascular death [HR 1.87 (95%CI 1.20-2.92)] and 59% higher risk of all-cause mortality [HR 1.59 (95%CI 1.28-1.96)], compared with the lowest tertile (< 4.3 mg/g).
UNASSIGNED: In a nationally representative sample of relatively healthy community-dwelling adults, higher levels of albuminuria in the conventionally \"normal\" range <30 mg/g in healthy individuals are associated with greater mortality. Overall, our findings contribute to the growing body of evidence on the existence of a risk gradient across all levels of albuminuria, even in the so-called normal range.
UNASSIGNED: We studied adults who participated in the 1999-2014 National Health and Nutrition Examination Survey. We excluded participants with baseline cardiovascular disease, hypertension, diabetes, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, those who were currently pregnant, and those who had received dialysis in the last year. After excluding these conditions, only 5.0% of the remaining population had UACR ≥30 mg/g (N=873) and were excluded. The final sample size was 16,247. We assessed the relationship between UACR and cardiovascular and all-cause mortality using multivariable-adjusted Cox proportional hazards models. Models were adjusted for age, sex, race or ethnicity, smoking status, systolic blood pressure, hemoglobin A1c, total cholesterol, health insurance, food insecurity, serum albumin, body mass index, use of statins, and eGFR.
UNASSIGNED: Mean age was 38.9 years (SD 13.6) and 53.7% were women. The median length of follow-up was 12.2 years. In multivariable-adjusted models, each doubling of UACR (within the <30 mg/g range) was associated with a 36% higher risk of cardiovascular death [HR 1.36 (95% confidence interval (CI) 1.11-1.65)] and a 28% higher risk of all-cause mortality [HR 1.28 (95%CI 1.17-1.41)]. The highest tertile of UACR (7.1-29.9 mg/g) was associated with an 87% higher risk of cardiovascular death [HR 1.87 (95%CI 1.20-2.92)] and 59% higher risk of all-cause mortality [HR 1.59 (95%CI 1.28-1.96)], compared with the lowest tertile (< 4.3 mg/g).
UNASSIGNED: In a nationally representative sample of relatively healthy community-dwelling adults, higher levels of albuminuria in the conventionally \"normal\" range <30 mg/g in healthy individuals are associated with greater mortality. Overall, our findings contribute to the growing body of evidence on the existence of a risk gradient across all levels of albuminuria, even in the so-called normal range.
摘要：
■白蛋白尿与患有潜在心血管疾病和糖尿病的成年人的心血管事件有关，即使尿白蛋白排泄水平较低。我们假设在正常范围内（尿白蛋白与肌酸比值（UACR）<30mg/g）的低水平白蛋白尿与明显健康的成年人的心血管死亡有关。
■我们研究了参加1999-2014年全国健康和营养调查的成年人。我们排除了基线心血管疾病的参与者，高血压,糖尿病,估计肾小球滤过率(eGFR)<60ml/min/1.73m2，那些目前怀孕的人，以及去年接受透析的人。排除这些条件后，其余人群中UACR≥30mg/g(N=873)仅5.0%被排除.最终样本量为16,247。我们使用多变量校正Cox比例风险模型评估UACR与心血管和全因死亡率之间的关系。模型根据年龄进行了调整，性别,种族或民族,吸烟状况,收缩压,血红蛋白A1c，总胆固醇,健康保险,粮食不安全，血清白蛋白,身体质量指数,他汀类药物的使用，和eGFR。
■平均年龄为38.9岁（SD13.6），女性占53.7％。中位随访时间为12.2年。在多变量调整模型中，UACR每加倍(<30mg/g范围内)与心血管死亡风险增加36%[HR1.36(95%可信区间(CI)1.11~1.65)]和全因死亡风险增加28%[HR1.28(95CI1.17~1.41)]相关.UACR的最高三元组（7.1-29.9mg/g）与心血管死亡风险增加87％[HR1.87（95CI1.20-2.92）]和全因死亡风险增加59％[HR1.59（95CI1.28-1.96）]相关，与最低三分位数（<4.3mg/g）相比。
■在具有全国代表性的相对健康的社区居住成年人样本中，在常规的“正常”范围<30mg/g的健康个体中,较高的白蛋白尿水平与较高的死亡率相关.总的来说,我们的发现有助于越来越多的证据表明，在所有水平的蛋白尿中都存在风险梯度，甚至在所谓的正常范围内。
■我们研究了参加1999-2014年全国健康和营养调查的成年人。我们排除了基线心血管疾病的参与者，高血压,糖尿病,估计肾小球滤过率(eGFR)<60ml/min/1.73m2，那些目前怀孕的人，以及去年接受透析的人。排除这些条件后，其余人群中UACR≥30mg/g(N=873)仅5.0%被排除.最终样本量为16,247。我们使用多变量校正Cox比例风险模型评估UACR与心血管和全因死亡率之间的关系。模型根据年龄进行了调整，性别,种族或民族,吸烟状况,收缩压,血红蛋白A1c，总胆固醇,健康保险,粮食不安全，血清白蛋白,身体质量指数,他汀类药物的使用，和eGFR。
■平均年龄为38.9岁（SD13.6），女性占53.7％。中位随访时间为12.2年。在多变量调整模型中，UACR每加倍(<30mg/g范围内)与心血管死亡风险增加36%[HR1.36(95%可信区间(CI)1.11~1.65)]和全因死亡风险增加28%[HR1.28(95CI1.17~1.41)]相关.UACR的最高三元组（7.1-29.9mg/g）与心血管死亡风险增加87％[HR1.87（95CI1.20-2.92）]和全因死亡风险增加59％[HR1.59（95CI1.28-1.96）]相关，与最低三分位数（<4.3mg/g）相比。
■在具有全国代表性的相对健康的社区居住成年人样本中，在常规的“正常”范围<30mg/g的健康个体中,较高的白蛋白尿水平与较高的死亡率相关.总的来说,我们的发现有助于越来越多的证据表明，在所有水平的蛋白尿中都存在风险梯度，甚至在所谓的正常范围内。
