Background
Methods
Study population and design
Clinical evaluation and laboratory measurements
Definition of UACR group and blood lipids categories
Statistical analysis
Results
Clinical characteristics of the study population
Variable | Total | UACR quartile | P value | |||
---|---|---|---|---|---|---|
Q 1 (n = 8645) | Q 2 (n = 8645) | Q 3 (n = 8645) | Q 4 (n = 8634) | |||
Age, years | 57.89 ± 9.38 | 55.87 ± 8.67 | 57.07 ± 8.90 | 58.41 ± 9.32 | 60.20 ± 10.02 | P < 0.001a,b,c,d,e,f |
Male sex, no. (%) | 11,390 (32.9) | 3946 (45.6) | 2779 (32.1) | 2283 (26.4) | 2382 (27.6) | P < 0.001 |
Current smoker, no. (%) | 4308 (12.5) | 1526 (17.7) | 1054 (12.2) | 827 (9.6) | 901 (10.4) | P < 0.001 |
Current drinker, no. (%) | 2394 (6.9) | 803 (9.3) | 563 (6.5) | 531 (6.1) | 497 (5.8) | P < 0.001 |
Previous MI, no. (%) | 115 (0.3) | 25 (0.3) | 22 (0.3) | 25 (0.3) | 43 (0.5) | P = 0.021 |
Previous stroke, no. (%) | 387 (1.1) | 69 (0.8) | 72 (0.8) | 111 (1.3) | 135 (1.6) | P < 0.001 |
Previous CHD, no. (%) | 1127 (3.3) | 190 (2.2) | 261 (3.0) | 269 (3.1) | 407 (4.7) | P < 0.001 |
TG, mmol/L | 1.32 (0.94, 1.32) | 1.26 (0.90, 1.80) | 1.30 (0.93, 1.88) | 1.32 (0.95, 1.91) | 1.43 (1.01, 2.09) | P < 0.001b,c,e,f |
TC, mmol/L | 4.99 ± 1.19 | 4.87 ± 1.17 | 4.98 ± 1.17 | 5.04 ± 1.19 | 5.07 ± 1.21 | P < 0.001a,b,c,d,e |
LDL-C, mmol/L | 2.94 ± 0.92 | 2.87 ± 0.90 | 2.94 ± 0.91 | 2.97 ± 0.92 | 2.97 ± 0.94 | P < 0.001a,b,c,e |
HDL-C, mmol/L | 1.30 ± 0.35 | 1.28 ± 0.35 | 1.31 ± 0.35 | 1.32 ± 0.35 | 1.28 ± 0.34 | P < 0.001a,b,e,f |
Non-HDL-C, mmol/L | 3.69 ± 1.05 | 3.59 ± 1.03 | 3.68 ± 1.03 | 3.72 ± 1.05 | 3.78 ± 1.08 | P < 0.001a,b,c,d,e,f |
ALT, U/L | 18.04 ± 13.91 | 17.98 ± 12.77 | 17.91 ± 13.49 | 17.71 ± 12.63 | 18.55 ± 16.36 | P < 0.001c,e,f |
AST, U/L | 21.71 ± 12.44 | 21.24 ± 11.84 | 21.56 ± 11.04 | 21.58 ± 10.52 | 22.47 ± 15.66 | P < 0.001c,e,f |
GGT, U/L | 28.73 ± 36.23 | 27.94 ± 34.17 | 27.49 ± 27.31 | 28.35 ± 37.02 | 31.12 ± 44.28 | P < 0.001c,e,f |
FBG, mmol/L | 5.96 ± 1.70 | 5.71 ± 1.24 | 5.80 ± 1.40 | 5.95 ± 1.65 | 6.39 ± 2.24 | P < 0.001a,b,c,d,e,f |
PBG, mmol/L | 8.45 ± 3.92 | 7.73 ± 3.15 | 8.06 ± 3.44 | 8.49 ± 3.93 | 9.52 ± 4.73 | P < 0.001a,b,c,d,e,f |
HbA1c, % | 6.08 ± 1.04 | 5.87 ± 0.73 | 5.97 ± 0.86 | 6.09 ± 1.04 | 6.37 ± 1.37 | P < 0.001a,b,c,d,e,f |
SBP, mmHg | 131.43 ± 20.30 | 126.43 ± 17.69 | 129.39 ± 19.17 | 131.89 ± 20.22 | 138.01 ± 22.07 | P < 0.001a,b,c,d,e,f |
DBP, mmHg | 77.47 ± 10.82 | 76.25 ± 10.16 | 76.94 ± 10.42 | 77.24 ± 10.75 | 79.44 ± 11.64 | P < 0.001a,b,c,e,f |
BMI, kg/m2 | 24.58 ± 3.66 | 24.36 ± 3.44 | 24.41 ± 3.62 | 24.45 ± 3.57 | 25.09 ± 3.96 | P < 0.001c,e,f |
Cr, mmol/L | 67.87 ± 16.75 | 69.16 ± 14.02 | 67.06 ± 16.01 | 66.33 ± 16.01 | 68.93 ± 20.17 | P < 0.001a,b,d,e,f |
eGFR, ml/min per 1.73 m2 | 95.39 ± 21.23 | 97.09 ± 21.10 | 96.13 ± 20.23 | 95.55 ± 20.74 | 92.80 ± 22.54 | P < 0.001a,b,c,e,f |
Associations of lipid parameters with quartiles of UACR
Variable | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |||||
---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | |
TG, mmol/L | ||||||||||
< 1.7 | Reference | Reference | Reference | Reference | Reference | |||||
1.7–2.2 |
1.125 (1.066, 1.187)
|
< 0.001
|
1.118 (1.058, 1.182)
|
< 0.001
|
1.115 (1.055, 1.179)
|
< 0.001
|
1.088 (1.029, 1.151)
|
0.003
| 1.022 (0.966, 1.081) | 0.451 |
≥ 2.3 |
1.301 (1.229, 1.377)
|
< 0.001
|
1.274 (1.200, 1.353)
|
< 0.001
|
1.285 (1.210, 1.364)
|
< 0.001
|
1.252 (1.179, 1.330)
|
< 0.001
|
1.131 (1.065, 1.203)
|
< 0.001
|
TC, mmol/L | ||||||||||
< 5.2 | Reference | Reference | Reference | Reference | Reference | |||||
5.2–6.1 | 1.076 (1.009, 1.147) | 0.026 | 1.056 (0.989, 1.128) | 0.100 | 1.036 (0.970, 1.106) | 0.289 | 1.047 (0.980, 1.118) | 0.170 | 1.038 (0.971, 1.108) | 0.274 |
≥ 6.2 | 1.018 (0.909, 1.140) | 0.754 | 1.000 (0.891, 1.123) | 0.996 | 0.950 (0.846, 1.067) | 0.385 | 0.978 (0.871, 1.098) | 0.706 | 0.966 (0.860, 1.086) | 0.565 |
LDL-C, mmol/L | ||||||||||
< 3.4 | Reference | Reference | Reference | Reference | Reference | |||||
3.4–4.0 | 1.215 (1.001, 1.475) | 0.049 | 1.230 (1.011, 1.498) | 0.039 | 1.204 (0.989, 1.466) | 0.065 | 1.213 (0.996, 1.477) | 0.055 | 1.139 (0.934, 1.389) | 0.199 |
≥ 4.1 | 1.249 (0.816, 1.912) | 0.306 | 1.267 (0.828, 1.940) | 0.276 | 1.238 (0.808, 1.897) | 0.327 | 1.256 (0.820, 1.925) | 0.295 | 1.215 (0.789, 1.870) | 0.376 |
HDL-C, mmol/L | ||||||||||
≥1.0 | Reference | Reference | Reference | Reference | Reference | |||||
< 1.0 | 0.958 (0.909, 1.009) | 0.107 | 0.963 (0.909, 1.021) | 0.210 | 0.998 (0.941, 1.058) | 0.942 | 0.975 (0.919, 1.034) | 0.403 | 0.952 (0.897, 1.010) | 0.106 |
Non-HDL-C, mmol/L | ||||||||||
< 4.1 | Reference | Reference | Reference | Reference | Reference | |||||
4.1–4.8 | 1.005 (0.936, 1.080) | 0.882 | 1.013 (0.942, 1.089) | 0.735 | 1.029 (0.957, 1.107) | 0.435 | 1.011 (0.940, 1.087) | 0.769 | 0.987 (0.917, 1.062) | 0.731 |
≥ 4.9 | 1.098 (0.975, 1.237) | 0.125 | 1.092 (0.967, 1.233) | 0.155 | 1.125 (0.996, 1.271) | 0.058 | 1.092 (0.966, 1.233) | 0.158 | 1.035 (0.916, 1.170) | 0.580 |
Variable | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |||||
---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | |
TG, mmol/L | ||||||||||
< 1.7 | Reference | Reference | Reference | Reference | Reference | |||||
1.7–2.2 |
1.226 (1.116, 1.346)
|
< 0.001
|
1.178 (1.069, 1.298)
|
0.001
|
1.179 (1.070, 1.299)
|
0.001
|
1.142 (1.036, 1.259)
|
0.008
| 1.075 (0.974, 1.186) | 0.151 |
≥ 2.3 |
1.408 (1.279, 1.549)
|
< 0.001
|
1.297 (1.172, 1.436)
|
< 0.001
|
1.292 (1.167, 1.430)
|
< 0.001
|
1.250 (1.129, 1.385)
|
< 0.001
|
1.134 (1.022, 1.258)
|
0.017
|
TC, mmol/L | ||||||||||
< 5.2 | Reference | Reference | Reference | Reference | Reference | |||||
5.2–6.1 | 1.046 (0.920, 1.189) | 0.492 | 1.018 (0.893, 1.160) | 0.793 | 1.030 (0.903, 1.174) | 0.660 | 1.041 (0.913, 1.186) | 0.553 | 1.007 (0.882, 1.150) | 0.916 |
≥ 6.2 | 0.943 (0.748, 1.188) | 0.616 | 0.899 (0.711, 1.137) | 0.376 | 0.910 (0.719, 1.151) | 0.430 | 0.939 (0.742, 1.188) | 0.599 | 0.872 (0.687, 1.107) | 0.260 |
LDL-C, mmol/L | ||||||||||
< 3.4 | Reference | Reference | Reference | Reference | Reference | |||||
3.4–4.0 | 0.964 (0.617, 1.506) | 0.872 | 0.939 (0.597, 1.476) | 0.784 | 0.914 (0.580, 1.438) | 0.697 | 0.941 (0.598, 1.482) | 0.794 | 1.004 (0.635, 1.586) | 0.987 |
≥ 4.1 | 1.309 (0.505, 3.393) | 0.579 | 1.376 (0.530, 3.569) | 0.512 | 1.437 (0.554, 3.728) | 0.457 | 1.486 (0.573, 3.855) | 0.416 | 1.623 (0.615, 4.284) | 0.328 |
HDL-C mmol/L | ||||||||||
≥1.0 | Reference | Reference | Reference | Reference | Reference | |||||
< 1.0 |
1.092 (1.008, 1.183)
|
0.030
|
1.109 (1.018, 1.208)
|
0.017
|
1.099 (1.008, 1.197)
|
0.031
|
1.060 (0.972, 1.155)
|
0.188
| 1.065 (0.976, 1.162) | 0.157 |
Non-HDL-C, mmol/L | ||||||||||
< 4.1 | Reference | Reference | Reference | Reference | Reference | |||||
4.1–4.8 | 0.966 (0.843, 1.108) | 0.621 | 0.988 (0.859, 1.136) | 0.863 | 0.987 (0.858, 1.134) | 0.850 | 0.962 (0.837, 1.107) | 0.592 | 0.954 (0.828, 1.099) | 0.516 |
≥ 4.9 | 1.189 (0.943, 1.500) | 0.143 | 1.184 (0.935, 1.498) | 0.160 | 1.175 (0.928, 1.487) | 0.181 | 1.128 (0.890, 1.428) | 0.319 | 1.133 (0.893, 1.438) | 0.304 |
Variable | Model 1 | Model 2 | Model 3 | Model 4 | Model 5 | |||||
---|---|---|---|---|---|---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | OR (95% CI) | P value | |
TG, mmol/L | ||||||||||
< 1.7 | Reference | Reference | Reference | Reference | Reference | |||||
1.7–2.2 |
1.098 (1.028, 1.173)
|
0.006
|
1.097 (1.025, 1.174)
|
0.008
|
1.093 (1.021, 1.170)
|
0.011
|
1.070 (0.999, 1.146)
|
0.053
| 1.000 (0.933, 1.072) | 0.994 |
≥ 2.3 |
1.313 (1.222, 1.410)
|
< 0.001
|
1.296 (1.202, 1.397)
|
< 0.001
|
1.290 (1.197, 1.391)
|
< 0.001
|
1.263 (1.171, 1.362)
|
< 0.001
|
1.129 (1.046, 1.219)
|
0.002
|
TC, mmol/L | ||||||||||
< 5.2 | Reference | Reference | Reference | Reference | Reference | |||||
5.2–6.1 | 0.954 (0.885, 1.028) | 0.218 | 0.941 (0.872, 1.016) | 0.123 | 0.944 (0.874, 1.019) | 0.138 | 0.953 (0.883, 1.029) | 0.222 | 0.941 (0.871, 1.017) | 0.123 |
≥ 6.2 |
0.806 (0.707, 0.920)
|
0.001
|
0.797 (0.696, 0.912)
|
0.001
|
0.798 (0.698, 0.913)
|
0.001
|
0.820 (0.716, 0.938)
|
0.004
|
0.812 (0.709, 0.930)
|
0.003
|
LDL-C, mmol/L | ||||||||||
< 3.4 | Reference | Reference | Reference | Reference | Reference | |||||
3.4–4.0 |
1.270 (1.023, 1.578)
|
0.031
|
1.300 (1.043, 1.620)
|
0.019
|
1.298 (1.042, 1.618)
|
0.02
|
1.303 (1.046, 1.624)
|
0.018
| 1.206 (0.966, 1.506) | 0.097 |
≥ 4.1 | 1.239 (0.768, 1.998) | 0.379 | 1.301 (0.806, 2.100) | 0.281 | 1.293 (0.801, 2.087) | 0.294 | 1.308 (0.810, 2.112) | 0.272 | 1.255 (.0.774, 2.036) | 0.357 |
HDL-C, mmol/L | ||||||||||
≥ 1.0 | Reference | Reference | Reference | Reference | Reference | |||||
< 1.0 | 1.064 (0.990, 1.144) | 0.09 | 1.044 (0.961, 1.135) | 0.307 | 1.041 (0.958, 1.131) | 0.347 | 1.023 (0.941, 1.112) | 0.594 | 0.987 (0.908, 1.074) | 0.765 |
Non-HDL-C, mmol/L | ||||||||||
< 4.1 | Reference | Reference | Reference | Reference | Reference | |||||
4.1–4.8 | 1.099 (1.010, 1.196) | 0.029 | 1.103 (1.012, 1.203) | 0.026 | 1.103 (1.012, 1.203) | 0.026 | 1.086 (0.996, 1.184) | 0.061 | 1.061 (0.973, 1.158) | 0.18 |
≥ 4.9 |
1.215 (1.055, 1.399)
|
0.007
|
1.200 (1.039, 1.385)
|
0.013
|
1.201 (1.040, 1.387)
|
0.013
|
1.171 (1.013, 1.352)
|
0.032
| 1.103 (0.954, 1.275) | 0.184 |
Associations between lipid parameters and UACR in people with LDL-C < 2.6 mmol/L or HDL-C > 1.0 mmol/L
Variable | LDL < 2.6 mmol/L | HDL > 1.0 mmol/L | ||
---|---|---|---|---|
OR (95% CI) | P value | OR (95% CI) | P value | |
TG, mmol/L | ||||
< 1.7 | Reference | Reference | ||
1.7–2.2 | 1.086 (0.977, 1.207) | 0.126 | 1.031 (0.969, 1.097) | 0.338 |
≥ 2.3 |
1.144 (1.030, 1.269)
|
0.012
|
1.148 (1.069, 1.232)
|
< 0.001
|
TC, mmol/L | ||||
< 5.2 | Reference | Reference | ||
5.2–6.1 | 1.076 (0.856, 1.353) | 0.528 | 1.040 (0.971, 1.113) | 0.259 |
≥ 6.2 | 0.673 (0.360, 1.256) | 0.213 | 0.967 (0.857, 1.092) | 0.589 |
LDL-C, mmol/L | ||||
< 3.4 | – | Reference | ||
3.4–4.0 | – | – | 1.140 (0.934, 1.393) | 0.198 |
≥ 4.1 | – | – | 1.250 (0.807, 1.935) | 0.318 |
HDL-C, mmol/L | ||||
≥ 1.0 | Reference | – | ||
< 1.0 | 0.985 (0.908, 1.068) | 0.708 | – | – |
Non-HDL-C, mmol/L | ||||
< 4.1 | Reference | Reference | ||
4.1–4.8 | 0.997 (0.753, 1.319) | 0.982 | 0.998 (0.923, 1.079) | 0.958 |
≥ 4.9 | 1.279 (0.756, 2.164) | 0.359 | 1.030 (0.904, 1.173) | 0.654 |
Associations of TG with quartiles of UACR and stratified analyses for different levels of eGFR, BMI, blood glucose and blood pressure
Variable | TG < 1.7 mmol/L | 1.7 ≤ TG < 2.3 mmol/L | TG ≥ 2.3 mmol/L | P-values for interaction | ||
---|---|---|---|---|---|---|
Reference | OR (95% CI) | P value | OR (95% CI) | P value | ||
eGFR, ml/min per 1.73 m2 a | 0.504 | |||||
eGFR ≥ 90 | 1 | 0.978 (0.902, 1.061) | 0.589 |
1.119 (1.008, 1.242)
|
0.035
| |
60 ≤ eGFE < 90 | 1 | 1.014 (0.929, 1.108) | 0.752 | 0.987 (0.881, 1.106) | 0.824 | |
eGFR < 60 | 1 | 1.401 (0.912, 2.153) | 0.124 | 1.609 (0.971, 2.667) | 0.065 | |
BMI, kg/m2 b | 0.081 | |||||
BMI < 18.5 | 1 | 1.472 (0.854, 2.539) | 0.164 | 2.145 (0.866, 5.315) | 0.099 | |
18.5 ≤ BMI < 24 | 1 | 1.016 (0.921, 1.120) | 0.753 | 1.077 (0.944, 1.227) | 0.270 | |
24 ≤ BMI < 28 | 1 | 1.000 (0.914, 1.093) | 0.992 |
1.153 (1.030, 1.291)
|
0.014
| |
BMI ≥ 28 | 1 | 1.013 (0.881, 1.163) | 0.861 | 0.933 (0.785, 1.107) | 0.425 | |
Blood glucose, mmol/Lc |
0.001
| |||||
FBG < 5.6 and PBG < 7.8 | 1 | 0.976 (0.881, 1.082) | 0.648 | 1.089 (0.945, 1.255) | 0.238 | |
5.6 ≤ FBG < 7.0 or 7.8 ≤ PBG < 11.1 | 1 | 1.001 (0.915, 1.096) | 0.981 |
1.139 (1.016, 1.277)
|
0.026
| |
FBG ≥ 7.0 or PBG ≥ 11.1 | 1 | 1.095 (0.969, 1.237) | 0.146 | 1.053 (0.909, 1.221) | 0.489 | |
BP, mmHgd | 0.068 | |||||
SBP < 120 and DBP < 80 | 1 | 1.100 (0.975, 1.242) | 0.12 | 1.044 (0.889, 1.226) | 0.602 | |
120 ≤ SBP < 140 and/or 80 ≤ DBP < 90 | 1 | 1.048 (0.954, 1.152) | 0.328 |
1.145 (1.015, 1.290)
|
0.027
| |
SBP ≥ 140 or DBP ≥ 90 | 1 | 0.968 (0.880, 1.066) | 0.51 | 1.102 (0.976, 1.244) | 0.116 |