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Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study.
J Am Heart Assoc. 2018 01 12; 7(2)JA

Abstract

BACKGROUND

Reduced estimated glomerular filtration rate (eGFR) and elevated urinary albumin-to-creatinine ratio (ACR) individually increase risk of cardiovascular disease (CVD). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels.

METHODS AND RESULTS

Using 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996-1998, we explored the cross-sectional association of eGFR and ACR with hemoglobin levels and their longitudinal associations with CVD (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (<13 g/dL in men and <12 g/dL in women) and 7.2% had high hemoglobin (≥16 g/dL in men and ≥15 g/dL in women). The adjusted prevalence ratio of anemia was 2.12 (95% confidence interval, 1.59-2.82) for eGFR 30 to 59 compared with ≥90 mL/min per 1.73 m2 and 1.45 (1.07-1.95) for ACR ≥30 compared with <10 mg/g. ACR ≥30 mg/g was also associated with high hemoglobin (prevalence ratio, 1.57 [1.12-2.19] compared with <10 mg/g). During follow-up, there were 1069 incident CVDs among 5098 CVD-free participants at baseline. In multivariable Cox models, lower eGFR, higher ACR, and anemia were each independently associated with CVD risk, with the association of low eGFR being slightly stronger in anemia (P-for-interaction, 0.072). There was no hemoglobin-ACR interaction; however, when CVD subtypes were analyzed separately, risk of coronary heart disease and stroke associated with high ACR was slightly stronger in high hemoglobin (P-for-interaction, 0.074).

CONCLUSIONS

Kidney function, albuminuria, and anemia were correlated and independently associated with CVD risk. Correlation and potential interaction for atherosclerotic CVD between albuminuria and high hemoglobin deserve further investigation.

Authors+Show Affiliations

Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Division of Nephrology, Department of Medicine, Johns Hopkins University, Baltimore, MD.Division of Hematology, Department of Medicine, Johns Hopkins University, Baltimore, MD.Department of Medicine, University of North Carolina at Chapel Hill, NC.Department of Epidemiology, University of North Carolina at Chapel Hill, NC.Department of Nephrology, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD.Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, Baltimore, MD kmatsush@jhsph.edu.

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural

Language

eng

PubMed ID

29330257

Citation

Ishigami, Junichi, et al. "Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: the ARIC (Atherosclerosis Risk in Communities) Study." Journal of the American Heart Association, vol. 7, no. 2, 2018.
Ishigami J, Grams ME, Naik RP, et al. Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc. 2018;7(2).
Ishigami, J., Grams, M. E., Naik, R. P., Caughey, M. C., Loehr, L. R., Uchida, S., Coresh, J., & Matsushita, K. (2018). Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study. Journal of the American Heart Association, 7(2). https://doi.org/10.1161/JAHA.117.007209
Ishigami J, et al. Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: the ARIC (Atherosclerosis Risk in Communities) Study. J Am Heart Assoc. 2018 01 12;7(2) PubMed PMID: 29330257.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study. AU - Ishigami,Junichi, AU - Grams,Morgan E, AU - Naik,Rakhi P, AU - Caughey,Melissa C, AU - Loehr,Laura R, AU - Uchida,Shinichi, AU - Coresh,Josef, AU - Matsushita,Kunihiro, Y1 - 2018/01/12/ PY - 2018/1/14/entrez PY - 2018/1/14/pubmed PY - 2019/9/26/medline KW - anemia KW - anemia and chronic kidney disease KW - cardiovascular disease KW - chronic kidney disease JF - Journal of the American Heart Association JO - J Am Heart Assoc VL - 7 IS - 2 N2 - BACKGROUND: Reduced estimated glomerular filtration rate (eGFR) and elevated urinary albumin-to-creatinine ratio (ACR) individually increase risk of cardiovascular disease (CVD). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels. METHODS AND RESULTS: Using 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996-1998, we explored the cross-sectional association of eGFR and ACR with hemoglobin levels and their longitudinal associations with CVD (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (<13 g/dL in men and <12 g/dL in women) and 7.2% had high hemoglobin (≥16 g/dL in men and ≥15 g/dL in women). The adjusted prevalence ratio of anemia was 2.12 (95% confidence interval, 1.59-2.82) for eGFR 30 to 59 compared with ≥90 mL/min per 1.73 m2 and 1.45 (1.07-1.95) for ACR ≥30 compared with <10 mg/g. ACR ≥30 mg/g was also associated with high hemoglobin (prevalence ratio, 1.57 [1.12-2.19] compared with <10 mg/g). During follow-up, there were 1069 incident CVDs among 5098 CVD-free participants at baseline. In multivariable Cox models, lower eGFR, higher ACR, and anemia were each independently associated with CVD risk, with the association of low eGFR being slightly stronger in anemia (P-for-interaction, 0.072). There was no hemoglobin-ACR interaction; however, when CVD subtypes were analyzed separately, risk of coronary heart disease and stroke associated with high ACR was slightly stronger in high hemoglobin (P-for-interaction, 0.074). CONCLUSIONS: Kidney function, albuminuria, and anemia were correlated and independently associated with CVD risk. Correlation and potential interaction for atherosclerotic CVD between albuminuria and high hemoglobin deserve further investigation. SN - 2047-9980 UR - https://www.unboundmedicine.com/medline/citation/29330257/Hemoglobin_Albuminuria_and_Kidney_Function_in_Cardiovascular_Risk:_The_ARIC__Atherosclerosis_Risk_in_Communities__Study_ L2 - https://www.ahajournals.org/doi/10.1161/JAHA.117.007209?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -