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Background  Microalbuminuria is associated with cardiovascular disease ( CVD ) mortality, but whether lower levels of urine albumin excretion similarly predict  CVD  is uncertain. We investigated associations between urine albumin:creatinine ratio ( UACR ) <30 mg/g, and incident hypertension, incident diabetes mellitus, and all‐cause and  CVD  mortality, during a maximum of 11 years of follow‐up.    Methods and Results  Individuals (37 091) in a health screening program between 2002 and 2012 with baseline measurements of  UACR  were studied. Cox proportional hazards models were used to estimate hazard ratios ( HR s) and 95% CIs for incident hypertension, incident diabetes mellitus, and mortality outcomes (lowest  UACR  quartile as reference) at follow‐up. For linear risk trends, the quartile rank was used as a continuous variable in regression models. Nine‐hundred sixty‐three cases of incident hypertension, 511 cases of incident diabetes mellitus, and 349 deaths occurred during follow‐up. In the fully adjusted models, there was a significant  HR  for the association between  UACR  and incident hypertension (highest  UACR  quartile  HR  1.95 [95%  CI  1.51, 2.53],  P ‐value for trend across  UACR  quartiles  P <0.001). In contrast, the association between  UACR  and incident diabetes mellitus was not significant (highest  UACR  quartile,  HR  1.15 [95%  CI  0.79, 1.66],  P ‐value for trend  P =0.20). For  CVD  mortality, with increasing  UACR  quartiles, there was a significant increase in  HR  across quartiles,  P =0.029, (for all‐cause mortality,  P =0.078).    Conclusions  Low levels of albuminuria,  UACR  below 30 mg/g, are associated with increased risk of incident hypertension and  CVD  mortality at follow‐up, but are not associated with increased risk of incident diabetes mellitus.

Urine Albumin/Creatinine Ratio Below 30 mg/g is a Predictor of Incident Hypertension and Cardiovascular Mortality