Urinary Albumin-to-Creatinine Ratio and Risk of Incident Cardiovascular Disease in the KoGES-ARIRANG Community-Based Cohort

Abstract

Purpose We aimed to assess whether low-grade albuminuria, characterized by a low urinary albumin-to-creatinine ratio (UACR) within the normal range (<30 mg/g), could predict cardiovascular disease (CVD) risk in a low-risk general population, with an emphasis on sex- and menopause-specific differences. Materials and Methods We analyzed data from 1327 participants from the Korean Genome and Epidemiology Study, excluding individuals with known CVD or major chronic illnesses, who were followed up for a median of 6.37 years. The UACR was measured from spot urine samples and treated as a continuous variable. The cardiovascular outcomes included stroke, myocardial infarction, and angina. Cox proportional hazards models and restricted cubic spline analyses were used to assess the association between UACR and incident CVD, stratified by sex and menopausal status. Results No significant association was observed between UACR and CVD in men or premenopausal women. However, in postmenopausal women, UACR was significantly associated with incident CVD (adjusted hazard ratio 1.09; 95% confidence interval: 1.01–1.18 per 1 mg/g increase). Spline analyses revealed a clear dose–response relationship in postmenopausal women, whereas no such pattern was observed in the other subgroups. Covariate-stratified analyses suggested a potential interaction effect of body mass index, blood pressure, and lipid profile. Conclusion Low-grade albuminuria may serve as an early biomarker of cardiovascular risk in otherwise healthy individuals, particularly in subgroups susceptible to hormonal or metabolic changes. Routine UACR screening may be a practical tool for early risk stratification and prevention of CVD.