Relation between albuminuria levels and the incidence of cardiovascular events in adult population in Northern Mexico: A 5-year follow-up survival analysis

Background Albuminuria has emerged as a key marker for cardiovascular (CV) and renal risk. Despite its clinical relevance, its role as a continuous and stratified predictor of ischemic CV events remains underexplored in Latin American populations, further evidence is needed to assess the prognostic value of urinary albumin-creatinine ratio (UACR) in this context. Methods A retrospective cohort of Mexican adults with UACR measured in 2019 and 5-year follow-up was conducted. UACR levels were classified per 2024 CKD Prognosis Consortium and KDIGO guidelines. Cox model regressions were used to analyze CV events—including myocardial infarction, ischemic stroke, heart failure, unstable angina, and transient ischemic attack —along with overall mortality and associated variables. Results Among 809 patients [mean (SD) age 55 · 2(12 · 5) years; 413 (51 · 1) males] followed over five years, those in the A3 albuminuria category (UACR ≥300 mg/g) had a significantly increased risk of ischemic CV events (HR ∼3 · 0) and all-cause mortality (HR > 4 · 5). Prior history of CV events, smoking, older age, and higher number of medical visits were also associated with CV events. An increase in mortality was seen since A1.2 albuminuria category. HbA1c, age, and male sex emerged as predictors of all-cause mortality. Conclusions Higher levels of UACR, starting from A1 category, were independently associated with increased risk of CV events and mortality. These findings support the use of UACR as a continuous and stratified marker for CV and renal risk in high-risk populations, even beyond the context of diabetes.