Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study

Abstract

BackgroundReduced 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 ResultsUsing 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).ConclusionsKidney 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.

Serum albumin level and long-term outcome in acute heart failure

“…The aetiology of anaemia is multifactorial, complex, and varies between patients. In HF, anaemia is considered to develop due to a complex interaction of iron deficiency, kidney disease and cytokine production, although micronutrient insufficiency and blood loss may also contribute [25,26]. All these factors are almost those associated with decreased serum albumin levels.…”

Association of Urine Albumin Excretion With Incident Heart Failure Hospitalization in Community-Dwelling Adults

“…Prior studies have examined the association of urine ACR with HF outcomes and in general, have shown that higher urine ACR is an independent risk factor for HF in general population-based cohorts (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19). However, these studies had low representation of black individuals or relatively few HF events, limiting their ability to determine whether the association of ACR with HF differed by race.…”

“…Whether similar racial differences exist in the relationship between urinary albumin excretion and HF is unclear. Most prior studies examining the relationship between urinary albumin excretion and HF outcomes in general population-based cohorts had relatively low representation of black individuals (7)(8)(9)(10)(11)(12)(13)(14)(15)(16)(17)(18)(19), limiting their ability to determine if there is racial heterogeneity in the association of urinary albumin excretion with HF. Further, only a few studies assessed the association of urine albumin excretion with HF by different HF subtypes (preserved vs. reduced ejection fraction) (10,11,15).…”

Short-Term Stability of Hematologic Parameters in Frozen Whole Blood

“…Hematologic parameters from the CBC are used to screen for a variety of conditions ranging from anemia to infections to thrombocytopenia (2). Certain components, particularly white blood cell count (WBC), platelet count (PLT), and hemoglobin (HGB) are associated with a variety of chronic conditions, including cancer, kidney disease, and cardiovascular disease (3–6). The stability and analytic variability of these parameters can have implications for studies evaluating the association of these parameters with risk of clinical outcomes.…”