Objective: To investigate the association of urinary albumin-to-creatinine ratio (UACR) in normal range and cardiovascular health (CVH) score with cardio-cerebroascular and all-cause mortality in urban elderly residents in Beijing. Methods: Based on Beijing Healthy Aging Cohort Study, data from 1 817 elderly participants with normal UACR were analyzed, and UACR was used as both continuous and categorical variable. "Life's Essential 8" was used to develop a CVH score. Statistical analysis was performed by using software SPSS 26.0 and R 4.2.1, including two independent samples t-test, χ2 test and non-parametric test. Multivariable Cox proportional hazard regression models stratified by CVH score and the restricted cubic spline were used to analyse the association of UACR with the risk for cardio-cerebrovascular and all-cause mortality. Results: By March 31, 2021, the median follow-up time M (Q1, Q3) was 11.28 (10.84, 11.36) years, a total of 308 deaths were recorded during follow-up, and the mortality density was 163.87/10 000 person-years. The age of the participants was (71.4±6.6) years, and 1 070 participants were women. The results showed that the risk for both cardio-cerebrovascular disease and all-cause mortality decreased with the decrease of UACR in the low CVH score group (HR=0.500, 95%CI: 0.341-0.734; HR=0.793, 95%CI: 0.647-0.971), and in the high CVH score group, there was a decreasing trend in the risk for cardio-cerebrovascular mortality with the decrease of UACR (HR=0.665, 95%CI: 0.447-0.990). Compared with the participants with low CVH score and higher UACR, the risk for cardio-cerebrovascular and all-cause mortality decreased by 68.9% and 45.6%, respectively, in the participants with high CVH score and lower UACR (HR=0.311, 95%CI: 0.131-0.739; HR=0.544, 95%CI: 0.360-0.822), and the risk for all-cause mortality decreased by 26.7% in the participants with high CVH score and higher UACR (HR=0.733, 95%CI: 0.542-0.993). Conclusions: In urban elderly residents in Beijing, higher UACR were associated with a significantly increased risk for cardio-cerebrovascular and all-cause mortality, and in the low-CVH score group, decreased UACR was protective factor against cardio-cerebrovascular and all-cause mortality. The combined effect of cardiovascular health status and normal UACR had a greater protection against the risk for cardio-cerebrovascular and all-cause mortality.
目的： 探讨北京市城市老年人群中正常范围内尿白蛋白-肌酐比值（UACR）和心血管健康（CVH）评分与心脑血管死亡及全因死亡的关联。 方法： 基于北京城乡健康老龄队列研究，对UACR处于正常范围内的1 817名老年研究对象进行数据分析。UACR同时作为连续变量和分类变量纳入研究。使用“生命八要素”制定CVH评分。使用SPSS 26.0和R 4.2.1软件进行t检验、χ2检验及非参数检验，使用限制性立方样条及多因素Cox比例风险回归模型探究UACR与心脑血管死亡及全因死亡的非线性关系和风险关联，并按CVH评分进行分层分析。 结果： 截至2021年3月31日，中位随访时间M（Q1，Q3）为11.28（10.84，11.36）年，随访期间共308名研究对象死亡，死亡密度为163.87/万人年。研究对象年龄为（71.4±6.6）岁；女性1 070名。低CVH评分组中，随着UACR降低，心脑血管死亡及全因死亡风险均存在下降趋势（HR=0.500，95%CI：0.341~0.734；HR=0.793，95%CI：0.647~0.971），高CVH评分组中，随着UACR降低，心脑血管死亡风险存在下降趋势（HR=0.665，95%CI：0.447~0.990）。与低CVH评分组和高UACR组相比，高CVH评分组和低UACR组的心脑血管死亡及全因死亡风险分别降低68.9%和45.6%（HR=0.311，95%CI：0.131~0.739；HR=0.544，95%CI：0.360~0.822），高CVH评分组和高UACR组的全因死亡风险降低26.7%（HR=0.733，95%CI：0.542~0.993）。 结论： 在北京市城市老年人群中，正常范围内UACR降低与心脑血管死亡及全因死亡风险降低相关，低CVH评分组中，UACR降低对心脑血管死亡及全因死亡均有保护作用，CVH状态与正常范围内UACR的联合效应对心脑血管死亡及全因死亡风险的保护效应更高。.