Scientific Reports · Oct 21, 2026
Association between urine calcium creatinine ratio and arterial stiffness among Chinese adults undergoing health screening with normal renal function
By Li Y, Ouyang W, Wu H et al.
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.