Stroke Risk and Urinary Albumin-to-Creatinine Ratio: A Post-Hoc Analysis of the ACCORD Trial
Abstract Body: Introduction: An elevated urinary albumin-to-creatinine ratio (UACR), a marker of renal dysfunction, has been linked to an increased incidence of stroke. However, the interplay between UACR and demographic factors such as age, obesity, ethnicity, or education remains underexplored.
Methods: We conducted a post-hoc analysis of the Action to Control Cardiovascular Risk in Diabetes (ACCORD) trial, including patients with available data. Time-to-event models were developed to examine the relation between UACR and stroke risk during up to 10 years of follow-up, adjusting for variables such as gender, age, education, and race. Because the exposure of UACR had a right skew, we transformed it into top tertile versus lowest/middle tertile.
Results: We included 9,025 ACCORD participants in our analyses. Baseline demographics are seen in Table 1. Those with elevated UACR (top tertile) had a higher incidence of stroke (4.6% vs 3.4%, p<0.001 in KM analysis, Figure 1). After adjusting for covariates, the multivariable Cox model still showed significance (adjusted HR 1.33, 95% CI 1.07-1.66, p=0.011). We further examined interactions between UACR and covariates including age, obesity, white vs other races, and education. For age and education, the interaction terms were not significant (p=0.216 and p=0.122). However, the interaction term for obesity warranted a stratified analysis (p=0.08). After stratification, we found that the effect of UACR was not significant in obese patients (p=0.385), but remained significant in non-obese participants (n=3345, HR 1.68, 95% CI 1.19-2.38, p=0.003). The interaction term for race was highly significant (p=0.01) and after stratification by race, UACR was not a significant predictor in white participants but showed significance in non-white patients (n=3373, HR 1.94, 95% CI 1.33-2.84, p=0.001).
Conclusion: Increased UACR is associated with a higher risk of stroke, with the effect being more pronounced in non-obese and non-white patients. Further studies are warranted to better understand the role of UACR in stroke incidence, particularly in the context of patient demographic factors.
Kim, Yvonne
( Yale University
, Salt Lake City
, Utah
, United States
)
Krothapalli, Neeharika
( Yale University
, Farmington
, Connecticut
, United States
)
Littig, Lauren
( Yale School of Medicine
, Fairfield
, Connecticut
, United States
)
De Havenon, Adam
( Yale University
, New Haven
, Connecticut
, United States
)
Author Disclosures:
Yvonne Kim:DO NOT have relevant financial relationships
| Neeharika Krothapalli:DO NOT have relevant financial relationships
| Lauren Littig:DO NOT have relevant financial relationships
| Adam de Havenon:DO have relevant financial relationships
;
Research Funding (PI or named investigator):NIH/NINDS:Active (exists now)
; Researcher:UptoDate:Active (exists now)
; Individual Stocks/Stock Options:Certus:Active (exists now)
; Individual Stocks/Stock Options:TitinKM:Active (exists now)
; Consultant:Novo Nordisk:Active (exists now)
; Research Funding (PI or named investigator):AAN:Active (exists now)
