Hemoglobin, albuminuria, and kidney function in cardiovascular risk: The ARIC (Atherosclerosis Risk in Communities) study

Junichi Ishigami, Morgan Grams, Rakhi Prakash Naik, Melissa C. Caughey, Laura R. Loehr, Shinichi Uchida, Josef Coresh, Kunihiro Matsushita

Research output: Contribution to journalArticle

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.

Original languageEnglish (US)
Article numbere007209
JournalJournal of the American Heart Association
Volume7
Issue number2
DOIs
StatePublished - Jan 1 2018

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Albuminuria
Albumins
Creatinine
Atherosclerosis
Hemoglobins
Cardiovascular Diseases
Glomerular Filtration Rate
Kidney
Anemia
Coronary Disease
Stroke
Proportional Hazards Models
Heart Failure
Confidence Intervals

Keywords

  • Anemia
  • Anemia and chronic kidney disease
  • Cardiovascular disease
  • Chronic kidney disease

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

@article{7689a189879c43d5acfc04a67ea12e82,
title = "Hemoglobin, albuminuria, and kidney function in cardiovascular risk: The ARIC (Atherosclerosis Risk in Communities) study",
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.",
keywords = "Anemia, Anemia and chronic kidney disease, Cardiovascular disease, Chronic kidney disease",
author = "Junichi Ishigami and Morgan Grams and Naik, {Rakhi Prakash} and Caughey, {Melissa C.} and Loehr, {Laura R.} and Shinichi Uchida and Josef Coresh and Kunihiro Matsushita",
year = "2018",
month = "1",
day = "1",
doi = "10.1161/JAHA.117.007209",
language = "English (US)",
volume = "7",
journal = "Journal of the American Heart Association",
issn = "2047-9980",
publisher = "Wiley-Blackwell",
number = "2",

}

TY - JOUR

T1 - Hemoglobin, albuminuria, and kidney function in cardiovascular risk

T2 - The ARIC (Atherosclerosis Risk in Communities) study

AU - Ishigami, Junichi

AU - Grams, Morgan

AU - Naik, Rakhi Prakash

AU - Caughey, Melissa C.

AU - Loehr, Laura R.

AU - Uchida, Shinichi

AU - Coresh, Josef

AU - Matsushita, Kunihiro

PY - 2018/1/1

Y1 - 2018/1/1

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.

AB - 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.

KW - Anemia

KW - Anemia and chronic kidney disease

KW - Cardiovascular disease

KW - Chronic kidney disease

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U2 - 10.1161/JAHA.117.007209

DO - 10.1161/JAHA.117.007209

M3 - Article

C2 - 29330257

AN - SCOPUS:85040915475

VL - 7

JO - Journal of the American Heart Association

JF - Journal of the American Heart Association

SN - 2047-9980

IS - 2

M1 - e007209

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