Association between Blood Urea Nitrogen to Serum Albumin Ratio and Carotid Plaque in Patients with Coronary Heart Disease postprint

Abstract: Background  The ratio of blood urea nitrogen（BUN）to serum albumin （ALB）（BAR）is an emerging biomarker that has been recently recognized to associate with adverse outcomes in a variety of cardiorespiratory disorders. However，the relationship between BAR and carotid plaque in patients with coronary heart disease（CHD）is currently unclear. Objective  To investigate the correlation between BAR and carotid plaque in CHD patients. Methods  Admission medical data of CHD patients hospitalized in six hospitals in Tianjin from January 2014 to September 2019 were retrospectively analyzed. BAR was calculated by dividing BUN by ALB. Logistic regression analysis was used to evaluate the correlation of BAR with the occurrence，number and characteristics of carotid plaque in CHD patients before and after adjusting for confounding factors. Drewa receiver operating characteristic（ROC）curve for diagnosing the risk of carotid plaque occurrence using BAR，and calculate the area under the ROC curve（AUC）. Results  A total of 10 808 cases of CHD were included. Among them，8 158 cases suffered from carotid plaque with a prevalence of 75.5%. The data of 10 808 CHD cases were divided into four groups by quartiles of BAR（Q1，Q2，Q3，Q4）for baseline analysis: Q1 ≤ -0.395 4，-0.395 4< Q2 ≤ -0.158 7，-0.158 7 < Q3 ≤ 0.132 4，and Q4 > 0.132 4. Compared with Q1，the correlation between BAR and carotid plaque formation was more significant in Q4 after multivariate adjustment（OR=1.512，95%CI=1.273-1.795，P<0.001）. The AUC for diagnosing the risk of carotid plaque in CHD patients with BAR is 0.612 （95%CI=0.600~0.624）. The correlation between BAR and plaque was more significant in the female population.（OR=1.583，95%CI=1.260-1.989，P<0.001），the correlation between BAR and plaque was more significant in the older age group（OR=1.810，95%CI=1.459-2.246，P<0.001）. The significant correlation between BAR and carotid plaque was not affected by diseases such as hypertension，hyperlipidemia and diabetes. Conclusion  High-level BAR is associated with carotid plaque formation, and which is more significant in women and middle-aged and elderly people. High level BAR is helpful in an early identification of carotid plaque formation in CHD patients，thus avoiding the occurrence of major adverse cardiovascular events（MACEs）.