Abstract 3536: Association of Albuminuria With New-onset Atrial Fibrillation In sTreated Hypertensive Patients: The LIFE Study
Background: Recent data from the LIFE trial showed a reduced rate of new-onset atrial fibrillation (AF) in hypertensive patients receiving losartan- compared to atenolol-based treatment. This effect can only partially be explained by effects of losartan on left atrial size and left ventricular (LV) mass. Micro- and macroalbuminuria independently predict cardiovascular disease in some populations and losartan reduces albuminuria. We evaluated relative levels of albuminuria and the incidence of new-onset AF in the LIFE study population.
Methods: A total of 8,243 hypertensive patients with ECG-documented LV hypertrophy (LVH), baseline albuminuria determinations and no prior AF were followed for 5.0+/−0.4 years after randomization to losartan- or atenolol-based antihypertensive therapy. ECGs were Minnesota coded for AF at regular revisits during the trial. Associations of micro- (3.5–35 mg/mmol) and macroalbuminuria (>35 mg/mmol) with new-onset AF were assessed using univariate and multivariate Cox models.
Results: In a univariate Cox model that considered micro- and macroalbuminuria only, new-onset AF in 350 patients was predicted strongly by baseline microalbuminuria (hazard ratio 1.41 [95% CI 1.11–1.80] p=0.005) and macroalbuminuria (2.96 [2.00 – 4.38] p<0.0001). In a multivariate Cox model that included other clinical covariates, baseline microalbuminuria no longer predicted AF (1.10 [0.85–1.42] p=0.478); however, macroalbuminuria predicted new AF (2.33 [1.55–3.49] p<0.0001) independently of female gender (0.60 [0.44 – 0.83] p=0.002), losartan treatment (0.65 [0.33– 0.91] p=0.006), baseline age (1.10 [1.08 –1.12] p<0.0001), BMI (1.03 [1.01–1.06] p=0.007), systolic blood pressure (1.01 [1.00 –1.02] p=0.008), and ECG LVH (1.52 [1.11–2.08] p=0.009).
Conclusion: Macroalbuminuria is an independent predictor of new-onset AF in hypertensive subjects with ECG LVH after adjustment for effects of antihypertensive treatment, age, gender, BMI, blood pressure and LVH.