CONTEXT The urinary albumin-to-creatinine ratio (UACR) is a widely used indicator of albuminuria and has predictive value for adverse cardiovascular events. OBJECTIVE To evaluate the correlation between the UACR and the risk of developing major adverse cardiovascular events (MACEs) and total mortality in patients with type 2 diabetes mellitus (T2DM). METHODS This post-hoc analysis included 10,171 participants from the Action to Control Cardiovascular Risk in Diabetes (ACCORD) study and the ACCORD Follow-up study with baseline UACR data. The natural logarithm (ln) of each UACR measurement was calculated. Univariate and multivariate Cox proportional hazard regression analyses were conducted to examine the association between the UACR and the risk of MACEs and total mortality. The additional predictive value of UACR was further evaluated. Similar methods were used to analyze the correlation between the UACR and MACEs and total mortality within the normal range. RESULTS During a median follow-up period of 8.83 years, 1808 (17.78%) participants experienced MACEs, and there were 1934 (19.01%) total mortality. After adjusting for traditional cardiovascular risk factors, the multivariate analysis revealed a significant association between the UACR and the risk of MACEs and total mortality. The inclusion of UACR in the conventional risk model enhanced the predictive efficacy for MACEs and total mortality. CONCLUSIONS An elevated UACR is associated with a higher risk of MACEs and total mortality in patients with T2DM, even when it falls below the normal range. The UACR improves MACE and total mortality risk prediction in patients with T2DM.

中文翻译：

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2 型糖尿病患者尿白蛋白与肌酐比率与心血管结果的关联。

背景 尿白蛋白与肌酐比值 (UACR) 是广泛使用的白蛋白尿指标，对不良心血管事件具有预测价值。目的 评估 2 型糖尿病 (T2DM) 患者的 UACR 与发生主要不良心血管事件 (MACE) 的风险和总死亡率之间的相关性。方法 这项事后分析包括来自控制糖尿病心血管风险行动 (ACCORD) 研究和 ACCORD 随访研究（使用基线 UACR 数据）的 10,171 名参与者。计算每个 UACR 测量值的自然对数 (ln)。进行单变量和多变量 Cox 比例风险回归分析，以检查 UACR 与 MACE 风险和总死亡率之间的关联。进一步评估了 UACR 的额外预测价值。采用类似方法分析UACR和MACE与正常范围内总死亡率之间的相关性。结果 在中位随访 8.83 年期间，1808 名参与者（17.78%）经历了 MACE，总死亡人数为 1934 名（19.01%）。调整传统心血管危险因素后，多变量分析显示 UACR 与 MACE 风险和总死亡率之间存在显着相关性。将 UACR 纳入传统风险模型增强了 MACE 和总死亡率的预测功效。结论 UACR 升高与 T2DM 患者较高的 MACE 风险和总死亡率相关，即使其低于正常范围。UACR 改善了 T2DM 患者的 MACE 和总死亡风险预测。