Abstract P308: Racial Differences in Albuminuria and Risk of Coronary Heart Disease
Background: Excess urinary albumin excretion is more prevalent in blacks than in whites and is a stronger risk factor for incident stroke and end stage renal disease in blacks as compared to whites. Whether the associations of urinary albumin excretion with coronary heart disease (CHD, defined as fatal CHD or nonfatal myocardial infarction) also differ by race is unknown.
Methods: Associations of urinary albumin to creatinine ratio (ACR) with physician-adjudicated CHD events were examined among 28,270 participants of the REasons for Geographic and Racial Differences in Stroke (REGARDS) study, a national prospective cohort of black and white adults ≥ 45 years. Proportional hazards analysis was used to examine associations of ACR with (1) incident CHD among the 23,304 free of CHD at baseline, and (2) first recurrent CHD event among the 4,966 with known CHD at baseline in blacks and whites, separately. Adjustment was made for baseline age, sex, geographic region of residence, income, education, waist circumference, blood pressure, lipids, smoking, physical activity, diabetes, medication use, high sensitivity c-reactive protein, and estimated glomerular filtration rate.
Results: A total of 618 incident and 480 first recurrent CHD events were observed over ~4.4 years of follow-up. In fully-adjusted models among those free of CHD at baseline, higher categories of ACR were associated with higher risk of incident CHD among blacks (ACR < 10 mg/g ref; 10 - 29.99, hazard ratio [HR] 1.8 95% confidence interval [CI] 1.2,2.3; 30 - 300, HR 2.3 95%CI 1.6,3.4; > 300 HR 2.6, 95%CI 1.4, 4.3) but not among whites (ACR < 10 mg/g ref; 10 - 29.99, HR 1.2 95%CI 0.9,1.6; 30 - 300, HR 1.2 95%CI 0.8,1.7; > 300 HR 1.8, 95%CI 0.9, 3.4). In contrast, among those with known CHD at baseline, associations of ACR with first recurrent CHD event were similar in blacks (ACR < 10 mg/g ref; 10 - 29.99, HR 1.3 95%CI 0.8,2.2; 30 - 300, HR 1.9 95%CI 1.2,3.2; > 300 HR 2.1, 95%CI 1.1, 4.0) as compared to whites (ACR < 10 mg/g ref; 10 - 29.99, HR 1.2 95%CI 0.9,1.7; 30 - 300, HR 1.5 95%CI 1.1,2.1; > 300 HR 2.5, 95%CI 1.6, 3.9).
Conclusion: Higher ACR was independently associated with higher risk of incident CHD in blacks but not whites. No racial differences were noted in the association of ACR with risk of recurrent CHD events.
- © 2013 by American Heart Association, Inc.