European Heart Journal Advance Access originally published online on May 11, 2007
European Heart Journal 2007 28(14):1739-1745; doi:10.1093/eurheartj/ehm130
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Low-grade albuminuria and the incidence of heart failure in a community-based cohort of elderly men
1 Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala Science Park, Uppsala SE-751 85, Sweden
2 Department of Medical Sciences, Uppsala University, Uppsala Science Park, Uppsala SE-751 85, Sweden
Received 6 December 2006; revised 23 March 2007; accepted 29 March 2007; online publish-ahead-of-print 11 May 2007.
* Corresponding author: Dag Hammarskjölds väg 14B, Uppsala, Sweden. Tel: +46 18 6117963; fax: +46 18 6117976. E-mail address: johan.arnlov{at}pubcare.uu.se
Aims: To investigate associations of urinary albumin excretion rate (UAER) and heart failure (HF) incidence in a community-based sample.
Methods and results: In a prospective study of 70-year-old men free from HF at baseline (n = 1106), UAER (from timed overnight samples) was analysed with established risk factors for HF [acute MI before baseline, acute MI during follow-up (modelled as a time-dependent covariate), hypertension, diabetes, left ventricular hypertrophy, smoking, body mass index, and glomerular filtration rate] and more recently described risk factors [high-sensitive C-reactive protein and insulin sensitivity (clamp glucose disposal rate)] as predictors of HF incidence.
Ninety-eight participants developed HF during a median follow-up of 9.0 years. In Cox proportional hazards models adjusted for established and novel risk factors for HF, a 1 SD increase in log UAER increased the risk of HF in individuals without anti-hypertensive treatment (hazard ratio 1.49; 95% CI 1.13–1.98; P = 0.005). Furthermore, UAER remained an independent predictor of HF, also in participants without diabetes at baseline or myocardial infarction at baseline or during follow-up. There were no significant associations between UAER and HF incidence in individuals with anti-hypertensive treatment.
Conclusion: Our observations support the notion that low-grade albuminuria is a marker for subclinical cardiovascular damage that predisposes to future HF in the community.
Key Words: Heart failure • Albuminuria • Kidney failure • Epidemiology • Risk factors
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