{"corpus_id":21849769,"paper_sha":"d37025c977eff7c9e066a6eb250e6237c275a1e1","doi":"10.1001/JAMA.286.4.421","arxiv_id":null,"pmid":11466120,"pmcid":null,"mag_id":2107031719,"dblp_id":null,"acl_id":null,"title":"Albuminuria and risk of cardiovascular events, death, and heart failure in diabetic and nondiabetic individuals.","year":2001,"publication_date":"2001-07-25","venue":"Journal of the American Medical Association (JAMA)","journal":{"name":"JAMA","pages":"\n          421-6\n        ","volume":"286 4"},"journal_issn":null,"journal_title":null,"publication_types":["Study","JournalArticle"],"pubmed_pub_types":["Journal Article","Multicenter Study","Research Support, Non-U.S. Gov't"],"s2_fields_of_study":["Medicine"],"reference_count":44,"citation_count":2280,"influential_citation_count":54,"is_open_access":true,"arxiv_categories":null,"arxiv_license":null,"arxiv_journal_ref":null,"mesh_headings":[{"d":"Aged","mj":false,"ui":"D000368"},{"d":"Albuminuria","mj":false,"qs":[{"q":"complications","mj":true,"ui":"Q000150"},{"q":"diagnosis","mj":false,"ui":"Q000175"}],"ui":"D000419"},{"d":"Cardiovascular Diseases","mj":false,"qs":[{"q":"epidemiology","mj":true,"ui":"Q000453"},{"q":"etiology","mj":false,"ui":"Q000209"},{"q":"mortality","mj":false,"ui":"Q000401"}],"ui":"D002318"},{"d":"Cause of Death","mj":false,"ui":"D002423"},{"d":"Cohort Studies","mj":false,"ui":"D015331"},{"d":"Creatinine","mj":false,"qs":[{"q":"blood","mj":false,"ui":"Q000097"},{"q":"urine","mj":false,"ui":"Q000652"}],"ui":"D003404"},{"d":"Diabetes Complications","mj":true,"ui":"D048909"},{"d":"Female","mj":false,"ui":"D005260"},{"d":"Heart Failure","mj":false,"qs":[{"q":"epidemiology","mj":false,"ui":"Q000453"}],"ui":"D006333"},{"d":"Humans","mj":false,"ui":"D006801"},{"d":"Likelihood Functions","mj":false,"ui":"D016013"},{"d":"Male","mj":false,"ui":"D008297"},{"d":"Middle Aged","mj":false,"ui":"D008875"},{"d":"Multivariate Analysis","mj":false,"ui":"D015999"},{"d":"Myocardial Infarction","mj":false,"qs":[{"q":"epidemiology","mj":false,"ui":"Q000453"}],"ui":"D009203"},{"d":"Proportional Hazards Models","mj":false,"ui":"D016016"},{"d":"Risk Factors","mj":false,"ui":"D012307"},{"d":"Stroke","mj":false,"qs":[{"q":"epidemiology","mj":false,"ui":"Q000453"}],"ui":"D020521"}],"chemicals":[{"n":"Creatinine","ui":"D003404","reg":"AYI8EX34EU"}],"comments_corrections":null,"source_flags":5,"s2_open_access_pdf_url":"https://jamanetwork.com/journals/jama/articlepdf/194038/JOC02030.pdf","s2_open_access_landing_url":"https://www.semanticscholar.org/paper/3c66192ec721a7d97f6f1c10f7ddbf401c4ad02a","s2_open_access_license":null,"s2_open_access_status":"BRONZE","pmc_open_access_pdf_url":null,"pmc_open_access_landing_url":null,"pmc_open_access_license":null,"pmc_open_access_status":null,"unpaywall_open_access_pdf_url":null,"unpaywall_open_access_landing_url":null,"unpaywall_open_access_license":null,"unpaywall_open_access_status":null,"abstract":"CONTEXT: Microalbuminuria is a risk factor for cardiovascular (CV) events. The relationship between the degree of albuminuria and CV risk is unclear. OBJECTIVES: To estimate the risk of CV events in high-risk individuals with diabetes mellitus (DM) and without DM who have microalbuminuria and to determine whether levels of albuminuria below the microalbuminuria threshold increase CV risk. DESIGN: The Heart Outcomes Prevention Evaluation study, a cohort study conducted between 1994 and 1999 with a median 4.5 years of follow-up. SETTING: Community and academic practices in North and South America and Europe. PARTICIPANTS: Individuals aged 55 years or more with a history of CV disease (n = 5545) or DM and at least 1 CV risk factor (n = 3498) and a baseline urine albumin/creatinine ratio (ACR) measurement. MAIN OUTCOME MEASURES: Cardiovascular events (myocardial infarction, stroke, or CV death); all-cause death; and hospitalization for congestive heart failure. RESULTS: Microalbuminuria was detected in 1140 (32.6%) of those with DM and 823 (14.8%) of those without DM at baseline. Microalbuminuria increased the adjusted relative risk (RR) of major CV events (RR, 1.83; 95% confidence interval [CI], 1.64-2.05), all-cause death (RR, 2.09; 95% CI, 1.84-2.38), and hospitalization for congestive heart failure (RR, 3.23; 95% CI, 2.54-4.10). Similar RRs were seen for participants with or without DM, even after adjusting for other CV risk factors (eg, the adjusted RR of the primary aggregate end point was 1.97 [95% CI, 1.68-2.31] in those with DM and 1.61 [95% CI, 1.36-1.90] in those without DM). Compared with the lowest quartile of ACR (<0.22 mg/mmol), the RRs of the primary aggregate end point in the second quartile (ie, ACR range, 0.22-0.57 mg/mmol) was 1.11 (95% CI, 0.95-1.30); third quartile, 1.38 (95% CI, 1.19-1.60; ACR range, 0.58-1.62 mg/mmol); and fourth quartile, 1.97 (95% CI, 1.73-2.25; ACR range, >1.62 mg/mmol) (P for trend <.001, even after excluding those with microalbuminuria). For every 0.4-mg/mmol increase in ACR level, the adjusted hazard of major CV events increased by 5.9% (95% CI, 4.9%-7.0%). CONCLUSIONS: Our results indicate that any degree of albuminuria is a risk factor for CV events in individuals with or without DM; the risk increases with the ACR, starting well below the microalbuminuria cutoff. Screening for albuminuria identifies people at high risk for CV events.","claims":[{"public_id":"cl_7750088542ec5853c228a23e24badb5a","status":"active","text":"Albuminuria screening identifies individuals at high risk for cardiovascular events.","confidence":0.93,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous (12632b8b5f)","roles":["extraction"],"url":"https://sah.borca.ai/u/12632b8b5f"}],"url":"https://sah.borca.ai/claims/cl_7750088542ec5853c228a23e24badb5a"},{"public_id":"cl_8ad49e040d9a9ba5625e8ce42fad89d9","status":"active","text":"Each 0.4-mg/mmol increase in albumin/creatinine ratio is associated with a 5.9% higher adjusted hazard of major cardiovascular events.","confidence":0.97,"contributors":[{"id":1,"public_id":"12632b8b5f","public_label":"Anonymous 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