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논문분류	춘계학술대회 초록집
제목	Albuminuria and Cardiovascular Diseases
저자	Hee Byung Koh
출판정보	2026; 2026(1):
키워드	albuminuria, coronary artery disease, atrial fibrillation, FURIN, hypertension
초록	Objectives: Albuminuria is well-known risk factor for cardiovascular diseases (CVDs) in patients, but whether this relationship is causal remains unclear. We aimed to investigate the bidirectional causal relationship between albuminuria and major cardiovascular diseases and to explore potential mediating mechanisms. Methods: We conducted an observational cohort analysis and a bidirectional two-sample Mendelian randomization (MR) study. The observational analysis included 170,518 participants from the UK Biobank. MR analyses were performed using summary statistics from CKDGen, UK Biobank, and FinnGen, predominantly involving individuals of European ancestry. The exposures were urinary albumin-to-creatinine ratio (uACR) and albuminuria (uACR ≥30 mg/g). Outcomes included incident coronary artery disease (CAD), stroke, heart failure (HF), and atrial fibrillation (AF). Observational associations were assessed using bidirectional Cox proportional hazards models. MR analyses employed inverse variance–weighted, weighted median, and MR-Egger approaches. Two-step MR and mediation analyses incorporating clinical risk factors and plasma protein quantitative trait loci were conducted to identify potential mediators. Results: In observational analyses, baseline albuminuria was independently associated with increased risks of CAD, stroke, HF, and AF. MR analyses demonstrated that genetically predicted higher uACR was causally associated with greater risks of CAD and AF but not stroke or HF. Reverse MR analyses provided no evidence that CVDs causally influence albuminuria. Mediation analyses showed that hypertension partially mediated the causal effects of albuminuria on CAD (41.2%) and AF (30.7%). Additionally, plasma FURIN levels mediated 18.9% of the causal effect of albuminuria on AF. Conclusion: Albuminuria appears to exert a unidirectional causal effect on the development of CAD and AF rather than serving solely as a marker of vascular risk. Hypertension and FURIN partially mediate these relationships, highlighting potential mechanistic pathways and reinforcing albuminuria as an active contributor to cardiovascular disease pathogenesis.
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