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Abstract
Background: The objective of this study was to examine the joint associations of estimated glomerular filtration rate (eGFR) and urinary albumin excretion with incident stroke in a large national cohort study.
Methods: Associations of urinary albumin to creatinine ratio (ACR) and eGFR with incident stroke were examined in 25,310 participants of the Reasons for Geographic and Racial Differences in Stroke (REGARDS) study, a prospective study of black and white US adults ≥45 years of age.
Results: A total of 548 incident strokes were observed over a median of 4.7 years of follow-up. Higher ACR values were associated with lower stroke-free survival in both black and white participants. Among black participants, as compared to an ACR <10 mg/g, the hazard ratios of stroke associated with an ACR of 10–29.99, 30–300, and >300 mg/g were 1.41 (95% confidence interval [CI] 1.01–1.98), 2.10 (95% CI 1.48–2.99), and 2.70 (95% CI 1.58–4.61), respectively, in analyses adjusted for traditional stroke risk factors and eGFR. In contrast, the hazard ratios among white subjects were only modestly elevated and not statistically significant after adjustment for established stroke risk factors. eGFR <60 mL/min/1.73 m2 was not associated with incident stroke in black or white participants after adjustment for established stroke risk factors.
Conclusions: Higher ACR was independently associated with higher risk of stroke in black but not white participants from a national cohort. Elucidating the reasons for these findings may uncover novel mechanisms for persistent racial disparities in stroke.
GLOSSARY
- ACR=
- albumin to creatinine ratio;
- CHD=
- coronary heart disease;
- CI=
- confidence interval;
- CKD=
- chronic kidney disease;
- eGFR=
- estimated glomerular filtration rate;
- HR=
- hazard ratio;
- REGARDS=
- Reasons for Geographic and Racial Differences in Stroke;
- WHO=
- World Health Organization
Footnotes
Study funding: Supported by a cooperative agreement U01 NS041588 from the National Institute of Neurological Disorders and Stroke, National Institutes of Health. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institute of Neurological Disorders and Stroke or the National Institutes of Health. Representatives of the funding agency have been involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. In addition, O.M.G. was supported by K23 DK081673 from the National Institute of Diabetes, Digestive and Kidney Diseases, National Institutes of Health. Additional funding was provided by an investigator-initiated grant-in-aid from Amgen Corporation. Amgen did not have any role in the design and conduct of the study, the collection, management, data analysis, or interpretation of the data, or the preparation of the manuscript. The manuscript was sent to Amgen Corporation for review prior to submission for publication.
Editorial, page 1634
- Received February 22, 2012.
- Accepted May 16, 2012.
- Copyright © 2012 by AAN Enterprises, Inc.
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