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1. Urinary albumin excretion serves as a proxy for kidney damage and has been linked to higher rates of coronary heart disease.
2. Black adults had a higher risk of incident coronary heart disease events with increased urinary albumin excretion when compared to white adults.
Evidence Rating Level: 1 (Excellent)
Study Rundown: This study is an offshoot of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study. The authors of this study have previously demonstrated that the albumin-to-creatinine ratio (ACR) was linked to higher rates of incident stroke in black adults as compared white adults. This current study sought to determine if the disparity extended to coronary heart disease (CHD) as well. ACR is regarded as a good measure of kidney injury and an increased ACR, greater than 30mg/g, is also considered a risk factor for cardiovascular disease.
It was found that after controlling for socioeconomic factors, medication use, and co-morbid conditions, higher ACRs were associated with greater risk of incident CHD events in black adults. Interestingly, recurrent CHD events were not associated with higher ACRs in neither black nor white adults. Explanations of the findings include increased susceptibility to vascular injury in black individuals as well as the relative poor preventative care available among the black population. Since kidney function has been related to heart disease it is also possible that differences in the rate of progression of kidney disease could have led to the findings. Causes of error endogenous to the data and study design may be related to the relatively low number of CHD cases in white males as well as a higher proportion of black adults in the highest ACR category.
Click to read the study in JAMA
Click to read an accompanying editorial in JAMA
Relevant Reading: Association of estimated glomerular filtration rate and albuminuria with all-cause mortality in general population cohorts
In-Depth [prospective cohort study]: This study included 23,273 participants without CHD and 4,934 patients with CHD. Participants were stratified by ACR level, less than 10mg/g, between 10-29.9 mg/g, 30-300 mg/g, and greater than 300 mg/g. Incidence rate ratios (IRRs) were increased at even the second lowest category, 10-29.9 mg/g ACR, in both blacks (2.20, CI 1.61-3.02) and whites (1.48, CI 1.15-1.90). After adjusting for age, sex, region, co-morbid condition, biochemical measures such as glomerular filtration rate, c-reactive protein and high-density lipoprotein, and medicine use, only black adults had an increasing risk of CHD events (1.84, CI 1.34-2.53) and association with ACR levels greater than 10mg/g (p=0.03). Black participants with an ACR >300mg/g, when compared to black participants with a ACR <10mg/g, had 3 times the risk of incident CHD. Interestingly, neither black nor white patients with previous CHD events (p=0.53) demonstrated an association between increasing ACR and risk of CHD.
By Ravi Shah and Brittany Hasty
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