{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,24]],"date-time":"2026-07-24T01:18:26Z","timestamp":1784855906664,"version":"3.55.0"},"reference-count":37,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"2","content-domain":{"domain":["www.ahajournals.org"],"crossmark-restriction":true},"short-container-title":["JAHA"],"published-print":{"date-parts":[[2018,1,23]]},"abstract":"\n Background<\/jats:title>\n \n Reduced estimated glomerular filtration rate (\n eGFR<\/jats:styled-content>\n ) and elevated urinary albumin\u2010to\u2010creatinine ratio (\n ACR<\/jats:styled-content>\n ) individually increase risk of cardiovascular disease (\n CVD<\/jats:styled-content>\n ). We hypothesized that these associations are stronger among people with abnormal (both low and high) hemoglobin levels.\n <\/jats:p>\n <\/jats:sec>\n \n Methods and Results<\/jats:title>\n \n Using 5801 participants with available hemoglobin measures of the ARIC (Atherosclerosis Risk in Community) study in 1996\u20131998, we explored the cross\u2010sectional association of\n eGFR<\/jats:styled-content>\n and\n ACR<\/jats:styled-content>\n with hemoglobin levels and their longitudinal associations with\n CVD<\/jats:styled-content>\n (heart failure, coronary heart disease, and stroke) risk through 2013. At baseline, 8.8% had anemia (<13\u00a0g\/dL in men and <12\u00a0g\/dL in women) and 7.2% had high hemoglobin (\u226516\u00a0g\/dL in men and \u226515\u00a0g\/dL in women). The adjusted prevalence ratio of anemia was 2.12 (95% confidence interval, 1.59\u20132.82) for\n eGFR<\/jats:styled-content>\n 30 to 59 compared with \u226590\u00a0mL\/min per 1.73\u00a0m\n 2<\/jats:sup>\n and 1.45 (1.07\u20131.95) for\n ACR<\/jats:styled-content>\n \u226530 compared with <10\u00a0mg\/g.\n ACR<\/jats:styled-content>\n \u226530\u00a0mg\/g was also associated with high hemoglobin (prevalence ratio, 1.57 [1.12\u20132.19] compared with <10\u00a0mg\/g). During follow\u2010up, there were 1069 incident\n CVD<\/jats:styled-content>\n s among 5098\n CVD<\/jats:styled-content>\n \u2010free participants at baseline. In multivariable Cox models, lower\n eGFR<\/jats:styled-content>\n , higher\n ACR<\/jats:styled-content>\n , and anemia were each independently associated with\n CVD<\/jats:styled-content>\n risk, with the association of low\n eGFR<\/jats:styled-content>\n being slightly stronger in anemia (\n P<\/jats:italic>\n \u2010for\u2010interaction, 0.072). There was no hemoglobin\u2010\n ACR<\/jats:styled-content>\n interaction; however, when\n CVD<\/jats:styled-content>\n subtypes were analyzed separately, risk of coronary heart disease and stroke associated with high\n ACR<\/jats:styled-content>\n was slightly stronger in high hemoglobin (\n P<\/jats:italic>\n \u2010for\u2010interaction, 0.074).\n <\/jats:p>\n <\/jats:sec>\n \n Conclusions<\/jats:title>\n \n Kidney function, albuminuria, and anemia were correlated and independently associated with\n CVD<\/jats:styled-content>\n risk. Correlation and potential interaction for atherosclerotic\n CVD<\/jats:styled-content>\n between albuminuria and high hemoglobin deserve further investigation.\n <\/jats:p>\n <\/jats:sec>","DOI":"10.1161\/jaha.117.007209","type":"journal-article","created":{"date-parts":[[2018,1,12]],"date-time":"2018-01-12T20:10:36Z","timestamp":1515787836000},"update-policy":"https:\/\/doi.org\/10.1161\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":38,"title":["Hemoglobin, Albuminuria, and Kidney Function in Cardiovascular Risk: The ARIC (Atherosclerosis Risk in Communities) Study"],"prefix":"10.1161","volume":"7","author":[{"given":"Junichi","family":"Ishigami","sequence":"first","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Morgan E.","family":"Grams","sequence":"additional","affiliation":[{"name":"Johns Hopkins University","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakhi P.","family":"Naik","sequence":"additional","affiliation":[{"name":"Johns Hopkins University","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Melissa C.","family":"Caughey","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Laura R.","family":"Loehr","sequence":"additional","affiliation":[{"name":"University of North Carolina at Chapel Hill"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shinichi","family":"Uchida","sequence":"additional","affiliation":[{"name":"Tokyo Medical and Dental University","place":["Tokyo, Japan"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Josef","family":"Coresh","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiro","family":"Matsushita","sequence":"additional","affiliation":[{"name":"Johns Hopkins Bloomberg School of Public Health","place":["Baltimore"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"key":"e_1_3_2_2_2","doi-asserted-by":"crossref","first-page":"703","DOI":"10.1038\/ki.2013.336","article-title":"Volume overload correlates with cardiovascular risk factors in patients with chronic kidney disease","volume":"85","author":"Hung SC","year":"2014","unstructured":"Hung SC, Kuo KL, Peng CH, Wu CH, Lien YC, Wang YC, Tarng DC. 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