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. 2019 May;7(5):394-401.
doi: 10.1016/j.jchf.2019.01.016.

Association of Urine Albumin Excretion With Incident Heart Failure Hospitalization in Community-Dwelling Adults

Luke N Bailey  1 , Emily B Levitan  2 , Suzanne E Judd  3 , Madeline R Sterling  4 , Parag Goyal  5 , Mary Cushman  6 , Monika M Safford  4 , Orlando M Gutiérrez  7
Affiliations

Association of Urine Albumin Excretion With Incident Heart Failure Hospitalization in Community-Dwelling Adults

Luke N Bailey et al. JACC Heart Fail. 2019 May.

Erratum in

  • Correction.
    Luke NB, Emily BL, Suzanne EJ, Madeline RS, Parag G, Mary C, Monika MS, Orlando MG. Luke NB, et al. JACC Heart Fail. 2019 Jul;7(7):636. doi: 10.1016/j.jchf.2019.05.002. JACC Heart Fail. 2019. PMID: 31248577 Free PMC article. No abstract available.

Abstract

Objectives: This study examined the association between urinary albumin excretion and incident heart failure (HF) hospitalization.

Background: Excess urinary albumin excretion is more strongly associated with incident stroke and coronary heart disease risk in black than in white individuals. Whether similar associations extend to HF is unclear.

Methods: This study examined the associations between the urinary albumin-to-creatinine ratio (ACR) and incident hospitalization for HF overall in 24,433 REGARDS (Reasons for Geographic and Racial Differences in Stroke) study participants free of suspected HF at baseline; findings were stratified by race and HF subtype (preserved vs. reduced ejection fraction). Models were adjusted for sociodemographic, clinical, and laboratory variables including estimated glomerular filtration rate, and multiple imputation was used to account for missing covariate data.

Results: After a median follow-up of 9.2 years, 881 incident HF events (332 preserved ejection fraction, 447 reduced ejection fraction, 102 unspecified) were observed. Compared to the lowest ACR category (<10 mg/g), the risk of incident HF increased with increasing ACR categories (10 to 29 mg/g hazard ratio [HR]: 1.49; 95% confidence interval [CI]: 1.26 to 1.78; 30 to 300 mg/g HR: 2.32; 95% CI: 1.93 to 2.78; >300 mg/g HR: 4.42; 95% CI: 3.36 to 5.83) in the fully adjusted model. Results did not differ by race. The magnitude of the association between ACR and HF with preserved ejection fraction was greater than with HF with reduced ejection fraction (HR comparing highest vs. lowest ACR category: 6.20; 95% CI: 4.15 to 9.26 vs. HR: 4.37; 95% CI: 3.00 to 6.25, respectively; p = 0.05).

Conclusions: Higher ACR was associated with greater risk of incident HF hospitalization in community-dwelling black and white adults.

Keywords: albumin-to-creatinine ratio; coronary heart disease; heart failure; urinary albumin.

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Figures

Figure.
Figure.
Age- and sex-adjusted incidence rate of heart failure hospitalization per 1000 person-years of follow-up as a function of urine albumin to creatinine ratio and estimated glomerular filtration rate categories
See this image and copyright information in PMC

Comment in

  • Urinalysis: A Window to the Heart.
    McMurray JJV. McMurray JJV. JACC Heart Fail. 2019 May;7(5):402-403. doi: 10.1016/j.jchf.2019.04.002. JACC Heart Fail. 2019. PMID: 31047020 No abstract available.

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