Effect of Urinary Albumin Creatinine Ratio on Cardiovascular Morbidity and Mortality in Diabetes Patients with Atherosclerotic Disease

Figures & data

Figure 1 Flow diagram.

Table 1 Demographic and Clinical Characteristics of DM Patients with ASCVD

Characteristics	Overall	uACR < 30mg/g	30~ 300mg/g	uACR≥ 300mg/g	P value
	N=2832	N=2195	N=434	N=203
Demographic characteristics
Age, year	63.3 (9.9)	63.0 (9.8)	65.0 (10.0)	63.9 (10.2)	<0.001
Women, n(%)	823 (29.1)	593 (27.0)	164 (37.8)	66 (32.5)	<0.001
Comorbidities
AMI, n(%)	432 (15.3)	298 (13.6)	85 (19.6)	49 (24.1)	<0.001
HT, n(%)	1927 (68.0)	1408 (64.1)	344 (79.3)	175 (86.2)	<0.001
CAD, n(%)	2579 (91.1)	1985 (90.4)	398 (91.7)	196 (96.6)	0.012
CKD, n(%)	585 (20.7)	312 (14.2)	138 (31.8)	135 (66.5)	<0.001
CHF, n(%)	430 (15.2)	265 (12.1)	101 (23.3)	64 (31.5)	<0.001
Anemia, n(%)	1047 (37.9)	711 (33.2)	208 (49.5)	128 (64.3)	<0.001
Laboratory tests
HbA1c, %	7.6 (1.5)	7.5 (1.5)	8.0 (1.7)	8.1 (1.8)	<0.001
LDLC, mmol/L	2.8 (0.9)	2.8 (0.9)	2.9 (0.9)	3.2 (1.1)	<0.001
HDLC, mmol/L	0.9 (0.2)	1.0 (0.2)	0.9 (0.2)	1.0 (0.3)	0.029
HGB, g/L	130.7 (18.3)	133.1 (16.2)	126.3 (19.5)	114.1 (25.3)	<0.001
Prior SCr, umol/L	0.9 [0.7, 1.1]	0.9 [0.7, 1.1]	1.0 [0.7, 1.2]	1.4 [0.9, 2.3]	<0.001
URIC, umol/L	411.9 (122.7)	404.2 (116.9)	426.5 (136.7)	466.7 (137.2)	<0.001
Medication
Statins, n(%)	1746 (96.3)	1380 (96.6)	244 (94.2)	122 (96.8)	0.172
Aspirin, n(%)	2452 (87.4)	1912 (87.7)	368 (86.0)	172 (87.3)	0.616
ACEI/ARB, n(%)	1313 (72.4)	1022 (71.5)	208 (80.3)	83 (65.9)	0.003
Spironolactone, n(%)	425 (15.2)	269 (12.3)	107 (25.0)	49 (24.9)	<0.001
β-blockers, n(%)	1525 (84.1)	1186 (83.0)	229 (88.4)	110 (87.3)	0.053
DAPT, n(%)	1345 (74.1)	1047 (73.3)	195 (75.3)	103 (81.7)	0.103
Procedure
PCI, n(%)	2016 (71.2)	1528 (69.6)	325 (74.9)	163 (80.3)	0.001

Abbreviations: AMI, Acute myocardial infarction; HT, Hypertension; CAD, Coronary artery disease; CKD, Chronic kidney disease; CHF, Congestive heart failure; HbA1c, Glycated hemoglobin; LDLC, Low density lipoprotein cholesterol; HDLC, High density lipoprotein cholesterol; HGB, Hemoglobin; Prior SCr, Prior serum creatinine; URIC, Uric acid; eGFR, Estimated glomerular filtration rate epidemiology collaboration equation; ACEI/ARB, Angiotensin converting enzyme inhibitors or angiotensin receptor blocker; DAPT, Dual-antiplatelet therapy; PCI, Percutaneous coronary intervention.

Table 2 Multivariate Risk Regression of Different Groups

	Groups	Events, n(%)	Model 1	Model 2	Model 3
			HR (95% CI)	HR (95% CI)	HR (95% CI)
Cardiovascular mortality	Group 1	55 (2.5)	1.00 (Ref)	1.00 (Ref)	1.00 (Ref)
	Group 2	43 (10.1)	4.33 (2.90–6.46)**	4.12 (2.76–6.15)**	3.08 (2.00–4.76)**
	Group 3	34 (16.9)	7.49 (4.87–11.53)**	7.28 (4.70–11.27)**	4.61 (2.60–8.17)**
All-cause mortality	Group 1	109 (5.0)	1.00 (Ref)	1.00 (Ref)	1.00 (Ref)
	Group 2	60 (13.8)	3.05 (2.22–4.18)**	2.95 (2.15–4.05)**	2.35 (1.67–3.30)**
	Group 3	43 (21.2)	4.95 (3.47–7.05)**	5.01 (3.51–7.14)**	3.02 (1.96–4.65)**

Notes: Group 1: uACR < 30mg/g; Group 2: 30mg/g ≤ uACR < 300mg/g; Group 3: uACR ≥ 300mg/g; Model 1: unadjusted; Model 2: adjusted for age, gender; Model 3: adjusted for age, gender, AMI, HT, CKD, CHF, anemia, HbA1c, LDLC, HDLC, PCI. **P < 0.001.

Figure 2 All-cause mortality and cumulative hazard (Kaplan-Meier).

Figure 3 Restricted spline curve and cox proportional hazards model of all-cause mortality.

Figure 4 Centre illustrations. Normal group: uACR < 30mg/g; Moderately increased group: 30mg/g < uACR < 300mg/g; Severely increased group: 300mg/g<uACR. ^#Adjusted for age, gender, AMI, HT, PCI, CKD, CHF, anemia, LDLC, HDLC, HbA1c.

Abbreviations: CIN II, Cardiorenal ImprovemeNt II; uACR, Urinary albumin creatinine ratio; CV, Cardiovascular; DM, Diabetes mellitus; ASCVD, Atherosclerotic cardiovascular disease; AMI, Acute myocardial infarction; HT, Hypertension; CKD, Chronic kidney disease; CHF, Congestive heart failure; HbA1c, Glycated hemoglobin; LDLC, Low-density lipoprotein cholesterol; HDLC, High-density lipoprotein cholesterol; PCI, Percutaneous coronary intervention.