These findings highlight the importance of risk management for early kidney dysfunction, particularly among individuals with poor CVH.Ĭhronic kidney disease (CKD) is a major public health issue and directly contributes to the global burden of incidence and mortality, 1, 2 yet CKD often goes undiagnosed due to a lack of apparent symptoms in the early stages. Compared with the low UACR group, high UACR in the normal range showed an increased mortality risk in the moderate and poor CVH groups (CVH : HR, 1.54 CVH : HR, 1.56 ), with a significant multiplicative interaction of UACR and CVH ( P < .001).Ĭonclusions and Relevance The findings suggest that high UACR within the normal range is associated with a significantly increased risk of all-cause mortality, with the association more pronounced in adults with poor CVH status. Near-linear associations were observed for continuous UACR and CVH with all-cause mortality. During the median 7.8 years (range, 4.5-11.1 years) of follow-up, 1403 deaths were recorded. Results The study included 23 697 participants (mean age, 45.58 years 11 806 women and 11 891 men ). Main Outcomes and Measures Multivariable Cox proportional hazards regression was used to estimate hazard ratios (HRs) and 95% CIs for associations of UACR with all-cause mortality in total participants and as stratified by CVH groups. Cardiovascular health was assessed using Life’s Essential 8 scores and grouped as poor (0-49 points), moderate (50-79 points), and ideal (80-100 points). The study included adult participants aged 20 to 79 years with a normal UACR (<30 mg/g) based on Kidney Disease: Improving Global Outcomes criteria.Įxposures The UACR was treated as a continuous variable and categorized into tertiles delineated as low (<4.67 mg/g), medium (4.67-7.67 mg/g), and high (7.68 to <30 mg/g). Data were analyzed from March 1 through October 31, 2023. Objective To investigate associations of traditionally normal UACR and CVH with all-cause mortality.ĭesign, Setting, and Participants This cohort study used National Health and Nutrition Examination Survey data from 2005 through 2018 and linked mortality information until 2019. Importance Although cumulative evidence suggests that elevated urinary albumin-to-creatinine ratio (UACR) in the normal range (<30 mg/g) may be associated with an increased risk of mortality, few studies have investigated whether cardiovascular health (CVH) modifies the harmful outcomes of high-normal UACR. Shared Decision Making and Communication.Scientific Discovery and the Future of Medicine.Health Care Economics, Insurance, Payment.Clinical Implications of Basic Neuroscience.Challenges in Clinical Electrocardiography.HRs (95% CIs) for Associations of UACR With All-Cause Mortality Stratified by CVH Groups, After Adjusting for Hypertension and Diabetes Selection of Study Participants From the 2005 to 2018 Cycles of the National Health and Nutrition Examination SurveyĮFigure 2. Estimated Direct and Indirect Effect Sizes of Cardiovascular Health With All-Cause Mortality Through UACR in the National Health and Nutrition Examination Survey, 2005 to 2018ĮFigure 1. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality Stratified by CVH With Additional Adjustment for Hypertension and DiabetesĮTable 13. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality Stratified by CVH After Excluding Death Within the First 2 Years of Follow-UpĮTable 12. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality Stratified by CVH After Exclusion of Participants Whose eGFR was <60 mL/min/1.73 m 2ĮTable 11. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality in Models Further Adjusted for Covariates of CVHĮTable 10. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality Stratified by Diabetes and CVHĮTable 9. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality Stratified by Hypertension and CVHĮTable 8. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality Stratified by Age and CVHĮTable 7. Adjusted Hazard Ratios and 95% CIs of UACR With Risk of All-Cause Mortality Stratified by Sex and CVHĮTable 6. Adjusted Hazard Ratios and 95% CIs of CVH With Risk of All-Cause MortalityĮTable 5. Comparisons of Baseline Characteristics Between Participants With Complete Data and Those With Missing CVH DataĮTable 4. Cardiovascular Health Metrics Based on UACR Levels in NHANES 2005-2018ĮTable 3. Definition and Scoring Approach for the American Heart Association’s Life’s Essential 8 ScoreĮTable 2. Information on Collection and Measurements for the Components of CVHĮTable 1.
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