Association between urinary albumin excretion and coronary heart disease in black vs white adults.

Abstract

Increased urinary albumin excretion (generally defined as an albumin-to-creatinine ratio [¹] ≥30 mg/g) is an important marker of kidney injury and a strong risk factor for cardiovascular disease.¹ Black individuals have higher levels of urinary albumin excretion than white individuals,^2-6 which may contribute to racial disparities in cardiovascular outcomes. In support of this, in participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study free of stroke at baseline, we previously showed that the association of urinary ACR with incident stroke differed by race, such that higher urinary ACR was independently associated with a greater risk of incident stroke in black individuals but not in white individuals.⁶ Although these data suggest that higher urinary albumin excretion may be a stronger risk factor for cardiovascular disease events in black individuals than in white individuals, little is known about racial differences in the association of urinary ACR with cardiovascular outcomes apart from stroke events. In particular, no study to our knowledge has specifically examined whether the association of urinary ACR and coronary heart disease (²) differs by race. Accordingly, we examined the associations of ACR with both incident and recurrent CHD events in black and white participants of the REGARDS study.