Why UACR Matters for Cardiovascular Risk

Cardiovascular (CV) disease remains the leading cause of death among people with type 2 diabetes (T2D), and the risk often starts to rise long before symptoms appear.¹,² One clinically meaningful indicator of elevated CV risk can be detected through a simple urine test: the urine albumin-to-creatinine ratio (UACR) which is commonly used to detect chronic kidney disease (CKD) in these patients.³ Yet, a 2025 national survey of 600+ HCPs (sponsored by Bayer) found only 5% of HCPs cite assessing cardiovascular risk as the main reason for ordering a UACR test, suggesting that its broader significance may not always be fully recognized.⁴

Bayer’s Reveal the CV Risk campaign is designed to increase understanding that elevated UACR (≥30 mg/g), while commonly used to identify kidney damage, is also associated with a higher risk of cardiovascular disease in people with type 2 diabetes.⁵

Current ADA Standards of Care emphasize routine assessment of albuminuria to support risk stratification and guide comprehensive risk management in T2D, including optimization of evidence based therapies when appropriate.⁵

UACR measures the amount of albumin relative to creatinine in the urine. Elevated UACR can signal systemic vascular endothelial dysfunction, also known as widespread damage to your blood vessels in organs like the heart and kidney.⁶ While elevated UACR is a marker of CKD it is also a sign of increased CV risk.⁶

Clinical guidelines from organizations like the American Diabetes Association, American Heart Association, American College of Cardiology, and Kidney Disease: Improving Global Outcomes recognize UACR ≥30 mg/g as a marker of kidney damage that is associated with increased cardiovascular risk.5,7,8, A UACR level ≥30 mg/g is associated with a five-times higher risk of hospitalization due to heart failure, a four-times higher risk of CV death, and a three-times higher risk of heart attack.9 When elevated UACR goes unrecognized, opportunities to intervene earlier may be missed. 

In patients with T2D, incorporating UACR into annual testing and repeating it every three months when elevated, can help shift cardiovascular and kidney care from reactive to proactive.⁵

Peer-to-peer digital education can help translate clinical concepts into everyday practice, particularly when addressing gaps in awareness.
To help primary care physicians recognize elevated UACR as an urgent signal and act promptly on its implications, Bayer teamed up with healthcare providers, including Dr. Ali Rida, a primary care physician who frequently shares educational perspectives on his social channels, to reinforce the role of UACR in detecting CV risk.

Q: Why is UACR an important test for primary care physicians to understand?
A: UACR can identify systemic vascular damage before symptoms appear. As physicians, we often chase after A1c and blood pressure. UACR deserves similar attention. Just as we wouldn’t ignore a high blood pressure because a patient is already on treatment, we shouldn’t overlook a UACR ≥30 mg/g, even when patients are on current standard of care. UACR adds valuable context to cardiovascular risk assessment in patients with T2D.

Q: How can greater awareness of UACR help patients?
A: Recognizing UACR as a marker associated with increased cardiovascular risk can shift conversations toward earlier, more proactive risk management rather than waiting for more advanced disease. Elevated UACR is associated with serious outcomes, including heart attack, hospitalization for heart failure, and CV death. Recognizing it earlier may help inform discussions aimed at reducing future risk.

Q: When should clinicians act on UACR results?
A: Persistent UACR of ≥30 mg/g indicates that a patient with T2D is at higher cardiovascular risk, in addition to being a marker of CKD. Acting with appropriate urgency, referring to guideline-recommended approaches, and individualizing care accordingly, can help reduce risk before opportunities for intervention are missed. 

As awareness of UACR continues to grow, ongoing clinician-led digital dialogue can play a key role in reinforcing its importance in assessing cardiovascular risk, not just kidney damage, in people with T2D, including those already receiving standard care. By supporting education that connects evidence to real-world practice, these efforts aim to help clinicians recognize risk earlier and foster informed conversations about monitoring,  care planning and treatment considerations, and long-term outcomes.

To learn more, visit www.hcplive.com/interactive-tools/revealthecvrisk.

eferences: 
_{^{1.    Einarson TR et al. Prevalence of cardiovascular disease in type 2 diabetes: a systematic literature review of scientific evidence from across the world in 2007-2017. Cardiovasc Diabetol. 2018;17(1):83. Published 2018 Jun 8. doi:10.1186/s12933-018-0728-6.
2.    Christofides EA, Desai N. Optimal Early Diagnosis and Monitoring of Diabetic Kidney Disease in Type 2 Diabetes Mellitus: Addressing the Barriers to Albuminuria Testing. J Prim Care Community Health. 2021;12:21501327211003683. doi:10.1177/21501327211003683 
3.    Palmer BF. Change in albuminuria as a surrogate endpoint for cardiovascular and renal outcomes in patients with diabetes. Diabetes Obes Metab. 2023 Feb 21. https://doi.org/10.1111/dom.15030.
4.    Bayer. Understanding UACR testing practices and perceptions in type 2 diabetes care: Results of a Sermo survey of primary care and nurse practitioners. Unpublished survey data. August 2025.
5.    American Diabetes Association Professional Practice Committee. Chronic kidney disease and risk management: Standards of care in diabetes—2024. Diabetes Care. 2024 Jan 1;47(Suppl 1):S219–S230. https://doi.org/10.2337/dc24-S011.
6.    Barzilay JI, Farag YMK, Durthaler J. Albuminuria: An underappreciated risk factor for cardiovascular disease. J Am Heart Assoc. 2024;13(2). https://doi.org/10.1161/JAHA.123.030131. 
7.    Jones, D, Ferdinand, K, Taler, S. et al. 2025 AHA/ACC/AANP/AAPA/ABC/ACCP/ACPM/AGS/AMA/ASPC/NMA/PCNA/SGIM Guideline for the Prevention, Detection, Evaluation, and Management of High Blood Pressure in Adults: A Report of the American College of Cardiology/American Heart Association Joint Committee on Clinical Practice Guidelines. JACC. 2025 Nov, 86 (18) 1567–1678.https://doi.org/10.1016/j.jacc.2025.05.007
8.    Kidney Disease: Improving Global Outcomes (KDIGO) Diabetes Work Group. KDIGO 2022 Clinical Practice Guideline for Diabetes Management in Chronic Kidney Disease. Kidney Int. 2022;102(5S):S1–S127. doi:10.1016/j.kint.2022.09.014  
9.    Rossing P, Epstein M. Microalbuminuria constitutes a clinical action item for
clinicians in 2021. Am J Med. 2022;135(5):576-580. doi:10.1016/j.amjmed.2021.11.019}}