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Carotid intima\u2013media thickness, brachial-ankle pulse wave velocity and ankle-brachial index were measured at baseline to assess subclinical atherosclerosis. After a median of 4.53 years\u2019 follow-up, 486 cardiovascular events and 230 all-cause deaths were recorded.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The urinary ACR levels were categorised into three groups. Compared with the normal group (0\u2264ACR &lt;7.82\u2009mg\/g), people with low-grade albuminuria (7.82\u2264ACR &lt;30\u2009mg\/g) and albuminuria (ACR \u226530\u2009mg\/g) had higher levels of subclinical atherosclerosis. In prospective analysis, people with low-grade albuminuria was not significantly associated with cardiovascular events (HR=1.18; 95% CI 0.95 to 1.46], whereas people with albuminuria had a 50% higher risk of cardiovascular events (HR=1.50; 95%\u2009CI 1.11 to 2.03). People with low-grade albuminuria and albuminuria had 43% (HR=1.43; 95%\u2009CI 1.05 to 1.93) and 87% (HR=1.87; 95%\u2009CI 1.24 to 2.81) higher risks of all-cause deaths during follow-up, respectively. In stratified analysis, the association of higher ACR with risks of cardiovascular events and all-cause deaths was stronger among individuals with concomitant subclinical atherosclerosis, the presence of diabetes and more cardiovascular risk factors, respectively.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>ACR levels were positively associated with subclinical atherosclerosis and predicted the risks of cardiovascular events and all-cause deaths. Evaluation of ACR levels should be integrated into risk stratification and prevention of cardiovascular events and all-cause deaths, especially among those with pre-existing subclinical atherosclerosis and cardiometabolic abnormalities.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjopen-2020-040890","type":"journal-article","created":{"date-parts":[[2021,3,3]],"date-time":"2021-03-03T11:28:48Z","timestamp":1614770928000},"page":"e040890","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":23,"title":["Urinary albumin-to-creatinine ratio levels are associated with subclinical atherosclerosis and predict CVD events and all-cause deaths: a prospective analysis"],"prefix":"10.1136","volume":"11","author":[{"given":"Shanshan","family":"Liu","sequence":"first","affiliation":[{"name":"Department of Endocrine and Metabolic Diseases, Shanghai Institute of Endocrine and Metabolic Diseases, Ruijin Hospital, Shanghai Jiaotong 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