Association Between Urinary Albumin Excretion and Coronary Heart Disease in Black vs White Adults

IMPORTANCE Excess urinary albumin excretion is more common in black than white individuals and is more strongly associated with incident stroke risk in black vs white individuals. Whether similar associations extend to coronary heart disease (CHD) is unclear. OBJECTIVE To determine whether the assoc...

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Bibliographic Details
Published in:JAMA : the journal of the American Medical Association 2013-08, Vol.310 (7), p.706-714
Main Authors: Gutiérrez, Orlando M, Khodneva, Yulia A, Muntner, Paul, Rizk, Dana V, McClellan, William M, Cushman, Mary, Warnock, David G, Safford, Monika M
Format: Article
Language:English
Subjects:
Adults
Age Factors
Aged
Albuminuria - ethnology
Biological and medical sciences
Black people
Black People - statistics & numerical data
Cardiology. Vascular system
Cardiovascular disease
Coronary Disease - ethnology
Coronary Disease - mortality
Coronary heart disease
Creatinine - urine
Female
General aspects
Heart
Humans
Incidence
Male
Medical sciences
Middle Aged
Myocardial Infarction - epidemiology
Myocardial Infarction - ethnology
Nephrology. Urinary tract diseases
Prospective Studies
Proteins
Recurrence
Risk
Sex Factors
United States - epidemiology
Urinary system involvement in other diseases. Miscellaneous
Urinary tract. Prostate gland
Urine
White people
White People - statistics & numerical data
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Description
Summary:IMPORTANCE Excess urinary albumin excretion is more common in black than white individuals and is more strongly associated with incident stroke risk in black vs white individuals. Whether similar associations extend to coronary heart disease (CHD) is unclear. OBJECTIVE To determine whether the association of urinary albumin excretion with CHD events differs by race. DESIGN, SETTING, AND PARTICIPANTS Prospective cohort study of black and white US adults aged 45 years and older who were enrolled within the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study between 2003 and 2007 with follow-up through December 31, 2009. We examined race-stratified associations of urinary albumin-to-creatinine ratio (ACR) in 2 groups: (1) incident CHD among 23 273 participants free of CHD at baseline; and (2) first recurrent CHD event among 4934 participants with CHD at baseline. MAIN OUTCOMES AND MEASURES Expert-adjudicated incident and recurrent myocardial infarction and acute CHD death. RESULTS A total of 616 incident CHD events (421 nonfatal MIs and 195 CHD deaths) and 468 recurrent CHD events (279 nonfatal MIs and 189 CHD deaths) were observed over a mean time of 4.4 years of follow-up. Among those free of CHD at baseline, age- and sex-adjusted incidence rates of CHD per 1000 person-years of follow-up increased with increasing categories of ACR in black and white participants, with rates being nearly 1.5-fold greater in the highest category of ACR (>300 mg/g) in black participants (20.59; 95% CI, 14.36-29.51) vs white participants (13.60; 95% CI, 7.60-24.25). In proportional hazards models adjusted for traditional cardiovascular risk factors and medications, higher baseline urinary ACR was associated with greater risk of incident CHD among black participants (hazard ratio [HR] comparing ACR >300 vs 300 vs 300 vs 300 vs
ISSN:0098-7484
1538-3598
1538-3598
DOI:10.1001/jama.2013.8777