Abstract 4057: Low-grade Albuminuria is an Independent Predictor of Heart Failure Incidence
Introduction Data are limited regarding the relations between albuminuria and incidence of congestive heart failure (CHF) in the general population.
Hypothesis We assessed the hypothesis that even low levels of albuminuria would predict future development of CHF, also after adjustment for potential confounders.
Methods In a community-based prospective study of 70-year old men free from CHF at baseline (n=1109), urinary albumin excretion rate (UAER, from timed overnight samples) was analyzed together with established risk factors for CHF (prior myocardial infarction, hypertension, diabetes, left ventricular hypertrophy, smoking and body mass index) and more recently described risk factors (high sensitive C-reactive protein [CRP] and insulin sensitivity [clamp glucose disposal rate]) as predictors of subsequent CHF incidence.
Results Ninety-eight participants developed CHF during a median follow-up of 9.0 years. In multivariable Cox proportional hazards models adjusted for established risk factors for CHF, a 1-SD increase of log-UAER increased the risk of CHF (hazard ratio, 1.28; 95% CI, 1.06–1.57; p=0.01). After adding CRP and clamp glucose disposal rate (reflecting insulin sensitivity) to the multivariable model, the results were similar. Participants with UAER >3.4 μg/min had a more than two-fold risk of CHF compared to participants with UAER ≤3.4 μg/min (hazard ratio 2.10, 95% CI 1.10– 4.02, p<0.03). Furthermore, UAER remained an independent predictor of CHF, also in participants without diabetes, macro- or microalbumin-uria (UAER<20 μg/min) at baseline or myocardial infarction at baseline or during follow-up.
Conclusions Our observations support the notion that low-grade albuminuria (well below the current threshold for microalbuminuria) is a marker for sub-clinical cardiovascular damage that predisposes to future heart failure in the community. Further studies are warranted to evaluate the clinical implications of our findings.