Abstract：
OBJECTIVE: The determine if elevated levels of albuminuria within the low range (urinary albumin-to-creatinine ratio, UACR <30 mg/g) are linked to cardiovascular death in adults lacking major cardiovascular risk factors.
METHODS: The association between UACR and cardiovascular mortality was investigated among 12,835 participants in the 1999-2014 National Health and Nutrition Examination Survey using Cox proportional hazard models and confounder-adjusted survival curves. We excluded participants with baseline cardiovascular disease, hypertension, diabetes, pre-diabetes, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, currently pregnant, and those who had received dialysis in the last year.
RESULTS: Over a median follow-up of 12.3 years, 110 and 621 participants experienced cardiovascular and all-cause mortality. In multivariable-adjusted models, each doubling of UACR was associated with a 36% higher risk of cardiovascular death [HR 1.36 (95% confidence interval (CI) 1.02-1.82)] and a 24% higher risk of all-cause mortality [HR 1.24 (95% CI 1.10-1.39)]. The 15-year adjusted cumulative incidences of cardiovascular mortality were 0.91%, 0.99%, and 2.1% for UACR levels of <4.18 mg/g, 4.18 to <6.91 mg/g, and ≥6.91 mg/g, respectively. The 15-year adjusted cumulative incidences of all-cause mortality were 5.1%, 6.1%, and 7.4% for UACR levels of <4.18 mg/g, 4.18 to <6.91 mg/g, and ≥6.91 mg/g, respectively.
CONCLUSIONS: Adults with elevated levels of albuminuria within the low range (UACR <30 mg/g) and no major cardiovascular risk factors had elevated risks of cardiovascular and all-cause mortality. The risks increased linearly with higher albuminuria levels. This emphasizes a risk gradient across all albuminuria levels, even within the supposedly normal range, adding to the existing evidence.
In this study of 12,835 adults without major cardiovascular risk factors (such as hypertension, cardiovascular disease, diabetes, pre-diabetes, or chronic kidney disease), we investigated the association between higher albuminuria levels within the low range (urine albumin-to-creatinine ratio (UACR) <30 mg/g) and both cardiovascular and all-cause mortality. Our findings revealed a linear increase in excess risk for both outcomes with rising albuminuria among relatively healthy adults. Each doubling of albuminuria was associated with a 36% higher risk of cardiovascular death (HR 1.36, 95% CI 1.02-1.82) and a 24% higher risk of all-cause mortality (HR 1.24, 95% CI 1.10-1.39). Each 10 mg/g increase in albuminuria was associated with 66% higher risk of cardiovascular mortality (HR 1.66, 95% CI 1.20, 2.28) and 41% higher risk of all-cause mortality (HR 1.41, 95% CI 1.17-1.68). These results challenge the assumption that UACR values below 30 mg/g are non-prognostic in adults without major cardiovascular risk factors.
METHODS: The association between UACR and cardiovascular mortality was investigated among 12,835 participants in the 1999-2014 National Health and Nutrition Examination Survey using Cox proportional hazard models and confounder-adjusted survival curves. We excluded participants with baseline cardiovascular disease, hypertension, diabetes, pre-diabetes, estimated glomerular filtration rate (eGFR) <60ml/min/1.73m2, currently pregnant, and those who had received dialysis in the last year.
RESULTS: Over a median follow-up of 12.3 years, 110 and 621 participants experienced cardiovascular and all-cause mortality. In multivariable-adjusted models, each doubling of UACR was associated with a 36% higher risk of cardiovascular death [HR 1.36 (95% confidence interval (CI) 1.02-1.82)] and a 24% higher risk of all-cause mortality [HR 1.24 (95% CI 1.10-1.39)]. The 15-year adjusted cumulative incidences of cardiovascular mortality were 0.91%, 0.99%, and 2.1% for UACR levels of <4.18 mg/g, 4.18 to <6.91 mg/g, and ≥6.91 mg/g, respectively. The 15-year adjusted cumulative incidences of all-cause mortality were 5.1%, 6.1%, and 7.4% for UACR levels of <4.18 mg/g, 4.18 to <6.91 mg/g, and ≥6.91 mg/g, respectively.
CONCLUSIONS: Adults with elevated levels of albuminuria within the low range (UACR <30 mg/g) and no major cardiovascular risk factors had elevated risks of cardiovascular and all-cause mortality. The risks increased linearly with higher albuminuria levels. This emphasizes a risk gradient across all albuminuria levels, even within the supposedly normal range, adding to the existing evidence.
In this study of 12,835 adults without major cardiovascular risk factors (such as hypertension, cardiovascular disease, diabetes, pre-diabetes, or chronic kidney disease), we investigated the association between higher albuminuria levels within the low range (urine albumin-to-creatinine ratio (UACR) <30 mg/g) and both cardiovascular and all-cause mortality. Our findings revealed a linear increase in excess risk for both outcomes with rising albuminuria among relatively healthy adults. Each doubling of albuminuria was associated with a 36% higher risk of cardiovascular death (HR 1.36, 95% CI 1.02-1.82) and a 24% higher risk of all-cause mortality (HR 1.24, 95% CI 1.10-1.39). Each 10 mg/g increase in albuminuria was associated with 66% higher risk of cardiovascular mortality (HR 1.66, 95% CI 1.20, 2.28) and 41% higher risk of all-cause mortality (HR 1.41, 95% CI 1.17-1.68). These results challenge the assumption that UACR values below 30 mg/g are non-prognostic in adults without major cardiovascular risk factors.
摘要：
目的：确定蛋白尿水平是否在低范围内升高（尿白蛋白与肌酐之比，UACR<30mg/g）与缺乏主要心血管危险因素的成年人的心血管死亡有关。
方法：在1999-2014年国家健康和营养检查调查中，使用Cox比例风险模型和混杂校正生存曲线，对12,835名参与者进行了UACR与心血管死亡率之间的关联研究。我们排除了基线心血管疾病的参与者，高血压,糖尿病,糖尿病前期,估计肾小球滤过率（eGFR）<60ml/min/1.73m2，目前正在怀孕，以及去年接受透析的人。
结果：经过12.3年的中位随访，110和621名参与者经历了心血管和全因死亡率。在多变量调整模型中，UACR的每加倍与心血管死亡风险增加36%[HR1.36(95%置信区间(CI)1.02~1.82)]和全因死亡率风险增加24%[HR1.24(95%CI1.10~1.39)]相关.15年调整后的心血管死亡率累积发生率为0.91%，0.99%,和2.1%的UACR水平<4.18毫克/克，4.18至<6.91mg/g，≥6.91mg/g，分别。全因死亡率的15年调整后累积发病率为5.1%，6.1%,和7.4%的UACR水平<4.18毫克/克，4.18至<6.91mg/g，≥6.91mg/g，分别。
结论：在低范围内（UACR<30mg/g）白蛋白尿水平升高且无主要心血管危险因素的成人心血管疾病和全因死亡率风险升高。随着蛋白尿水平的升高，风险呈线性增加。这强调了所有白蛋白尿水平的风险梯度，即使在所谓的正常范围内，增加现有证据。
在这项研究中，有12,835名没有主要心血管危险因素（例如高血压，心血管疾病,糖尿病,糖尿病前期,或慢性肾脏疾病)，我们调查了低范围(尿白蛋白/肌酐比值(UACR)<30mg/g)内较高的白蛋白尿水平与心血管死亡率和全因死亡率之间的关系.我们的发现表明，在相对健康的成年人中，白蛋白尿上升的两种结局的超额风险线性增加。每增加一倍的白蛋白尿与心血管死亡风险增加36%(HR1.36,95%CI1.02-1.82)和全因死亡风险增加24%(HR1.24,95%CI1.10-1.39)相关。每增加10mg/g的白蛋白尿与心血管死亡风险增加66％（HR1.66，95％CI1.20，2.28）和全因死亡风险增加41％（HR1.41，95％CI1.17-1.68）相关。这些结果挑战了以下假设：在没有主要心血管危险因素的成年人中，低于30mg/g的UACR值是非预后性的。
方法：在1999-2014年国家健康和营养检查调查中，使用Cox比例风险模型和混杂校正生存曲线，对12,835名参与者进行了UACR与心血管死亡率之间的关联研究。我们排除了基线心血管疾病的参与者，高血压,糖尿病,糖尿病前期,估计肾小球滤过率（eGFR）<60ml/min/1.73m2，目前正在怀孕，以及去年接受透析的人。
结果：经过12.3年的中位随访，110和621名参与者经历了心血管和全因死亡率。在多变量调整模型中，UACR的每加倍与心血管死亡风险增加36%[HR1.36(95%置信区间(CI)1.02~1.82)]和全因死亡率风险增加24%[HR1.24(95%CI1.10~1.39)]相关.15年调整后的心血管死亡率累积发生率为0.91%，0.99%,和2.1%的UACR水平<4.18毫克/克，4.18至<6.91mg/g，≥6.91mg/g，分别。全因死亡率的15年调整后累积发病率为5.1%，6.1%,和7.4%的UACR水平<4.18毫克/克，4.18至<6.91mg/g，≥6.91mg/g，分别。
结论：在低范围内（UACR<30mg/g）白蛋白尿水平升高且无主要心血管危险因素的成人心血管疾病和全因死亡率风险升高。随着蛋白尿水平的升高，风险呈线性增加。这强调了所有白蛋白尿水平的风险梯度，即使在所谓的正常范围内，增加现有证据。
在这项研究中，有12,835名没有主要心血管危险因素（例如高血压，心血管疾病,糖尿病,糖尿病前期,或慢性肾脏疾病)，我们调查了低范围(尿白蛋白/肌酐比值(UACR)<30mg/g)内较高的白蛋白尿水平与心血管死亡率和全因死亡率之间的关系.我们的发现表明，在相对健康的成年人中，白蛋白尿上升的两种结局的超额风险线性增加。每增加一倍的白蛋白尿与心血管死亡风险增加36%(HR1.36,95%CI1.02-1.82)和全因死亡风险增加24%(HR1.24,95%CI1.10-1.39)相关。每增加10mg/g的白蛋白尿与心血管死亡风险增加66％（HR1.66，95％CI1.20，2.28）和全因死亡风险增加41％（HR1.41，95％CI1.17-1.68）相关。这些结果挑战了以下假设：在没有主要心血管危险因素的成年人中，低于30mg/g的UACR值是非预后性的。
