Key result
Elevated urinary calcium-to-creatinine ratio is linked to ~2.1-fold higher risk of incident arterial stiffness.
Why the study?
Arterial stiffness is a precursor of CVD influenced by calcium metabolic homeostasis, and the urinary calcium-to-creatinine ratio (UCa/Cr) reflects calcium excretion status that may be associated with arterial stiffness.
Does a higher urinary calcium-to-creatinine ratio increase the risk of prevalent and incident moderate-to-severe arterial stiffness in Chinese adults with normal renal function?
Cohort (n=21,834)
No
Does a higher urinary calcium-to-creatinine ratio increase the risk of prevalent and incident moderate-to-severe arterial stiffness in Chinese adults with normal renal function?
Hazard Ratio: 2.12 (95% CI 1.18–3.82)
Absolute Event Rate: 29.97% vs 14.63%
p-value: p=0.010 for trend
In Chinese adults with normal renal function, an elevated spot urinary calcium-to-creatinine ratio is associated with higher odds of prevalent and incident moderate-to-severe arterial stiffness, though this relationship is largely attenuated after accounting for continuous blood pressure.
Association with incident arterial stiffness should not yet inform clinical risk assessment; leaves open independent prediction after blood pressure adjustment.
Arterial stiffness is a significant precursor of cardiovascular diseases (CVD), influenced by calcium metabolic homeostasis. The urinary calcium-to-creatinine ratio (UCa/Cr) reflects calcium excretion status and may be associated with arterial stiffness. This study included 21,834 subjects from annual health check-ups (2017–2020) and a prospective cohort of 3219 subjects followed from 2020 to 2024 at the Third Xiangya Hospital in Hunan, China. Arterial stiffness was assessed by brachial-ankle pulse wave velocity (baPWV) and classified as normal-to-mild (baPWV ≤ 1700 cm/s) or moderate-to-severe arterial stiffness (moderate-to-severe AS). Logistic regression models were used for cross-sectional analysis, and Cox proportional hazards models were used for the cohort analysis. In the cross-sectional study, a significant nonlinear association was observed between UCa/Cr and moderate-to-severe AS ( P overall < 0.001, P nonlinearity = 0.010). Compared with the lowest UCa/Cr group (< 0.049), the highest group (≥ 0.109) had a 36% higher odds of moderate‑to‑severe AS (aOR = 1.36, 95% CI: 1.11, 1.65). In the cohort study, over 7144 person-years of follow-up, 145 individuals developed moderate-to-severe AS. A significant overall association was observed between UCa/Cr and the risk of moderate-to-severe AS ( P overall = 0.014). Compared with the lowest UCa/Cr group (< 0.049), the highest group (≥ 0.109) had more than a two-fold higher risk of incident moderate‑to‑severe AS (aHR = 2.12, 95% CI: 1.18, 3.82). Further adjustment for continuous SBP and DBP attenuated both associations, which were no longer statistically significant. In the primary analyses, UCa/Cr was associated with both prevalent and incident moderate-to-severe AS, with the association most evident at higher UCa/Cr levels, but the findings were sensitive to adjustment for SBP.
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Li et al. (2026) conducted a cohort in Moderate-to-severe arterial stiffness (n=21,834). Highest quartile of urinary calcium-to-creatinine ratio (UCa/Cr ≥ 0.109 mg/mg) vs. Lowest quartile of urinary calcium-to-creatinine ratio (UCa/Cr < 0.049 mg/mg) was evaluated on Incident moderate-to-severe arterial stiffness (baPWV > 1700 cm/s) in the prospective cohort (HR 2.12, 95% CI 1.18-3.82, p=0.010 for trend). Elevated urinary calcium-to-creatinine ratio (≥0.109 vs <0.049 mg/mg) was associated with a two-fold higher risk of incident moderate-to-severe arterial stiffness (aHR 2.12, 95% CI 1.18-3.82).
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