Association Of Albumin Globulin Ratio With All-Cause And Cardiovascular Mortality In Chinese Population With H Type Hypertension

Objective:Previous literature data on AGR and cardiovascular death and all-cause death are few,and the conclusions are inconsistent.Therefore,the purpose of this study is to explore the relationship between AGR and cardiovascular death and all-cause death in Chinese adult patients with H type hypertension,and to explore whether there are effect modifiers that can change AGR and cardiovascular death and all-cause death.Methods:This study is a sub-study of the registration study of H-type hypertension in China(registration number: Chic TR 1800017274).From March 2018 to August 2018,14,089 subjects were continuously enrolled in Wuyuan County,Jiangxi Province,and a baseline survey was conducted.A 1.5-year follow-up was conducted in the later period to collect cardiovascular and cerebrovascular diseases,deaths and other events.Cox proportional hazards regression model was used to analyze the correlation between AGR and cardiovascular death and all-cause death.The outcome events of this study were divided into the main end event-all-cause death and the secondary end event-cardiovascular death.Results:After 1.5 years of follow-up,196 cases(1.39%)died of all causes and 110 cases(0.78%)died of cardiovascular.Cox proportional hazard regression showed that after adjusting for other confounding factors,the risk of all-cause death decreased by 77%for every increase of continuous variable AGR(HR: 0.23;95% CI:0.13-0.43);When the AGR trisection is used as the classification variable,the results show that compared with T3(AGR>1.8)group,the risk of all-cause death in T1 and T2 groups is increased,and their HR values are 1.91(95%CI 1.27,2.85)and 1.69(95%CI 1.12,2.57),respectively,because the trend P test is less than 0.05(P for trend=0.003),We use generalized addition model and smooth fitting curve(penalty spline method)to analyze the dose effect of AGR and all-cause death,and get the same result as regression analysis.However,the generalized addition model and smooth fitting curve(penalty spline method)show that there is an L-shaped curve relationship between AGR and cardiovascular death.Further,the threshold saturation effect is analyzed by Cox proportional risk regression model,and the inflection point of AGR is calculated to be1.33;When AGR≤1.33,the risk of cardiovascular death decreases with the increase of AGR value,and the risk decreases by 66% when AGR increases by 1(HR: 0.34;95%CI: 0.19-0.64);However,when AGR>1.33,the risk of cardiovascular death no longer changes with the increase of AGR value(HR:0.89;95%CI:0.71-1.11)。Subgroup analysis of the relationship between AGR and all-cause death showed that there was no interaction between AGR and other factors except diabetes.AGR in diabetic patients(HR=0.03)reduced the risk of death from all causes,which was significantly better than that in non-diabetic patients(HR=0.30).Subgroup analysis of the relationship between AGR and cardiovascular death showed that there was no interaction between each factor and AGR.Conclusion:The increase of AGR value can significantly reduce the risk of all-cause death in Chinese patients with H type hypertension complicated with diabetes.At the same time,AGR is in a certain range,and the increase of AGR level is closely related to the decrease of cardiovascular death risk.