Elevated urinary protein associated with HF events in patients with AF
Among Japanese patients with atrial fibrillation, elevated urinary protein may be an independent risk factor for HF events, according to a study published in European Heart Journal - Quality of Care and Clinical Outcomes.
“Proteinuria is an indicator of renal damage that is often detected earlier than any apparent decline in estimated glomerular filtration rate. ... Several recent studies have shown that proteinuria is independently associated with incidence of AF,” Syuhei Ikeda, MD, of the department of cardiology at the National Hospital Organization Kyoto Medical Center in Kyoto, Japan, and colleagues wrote. “Moreover, previous reports have demonstrated that proteinuria is associated with cardiovascular events such as stroke and thromboembolism in patients with AF. However, data regarding the association of proteinuria with HF events in patients with AF are lacking. The aim of the present study was to investigate the association between proteinuria and HF events in patients with AF, using data from a large-scale community-based prospective survey of Japanese patients with AF, the Fushimi AF Registry.”
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Researchers utilized the community-based prospective Fushimi AF Registry of patients with AF to assess the association between proteinuria and HF events. The primary outcome of HF events was a composite of cardiac death or HF hospitalization.
A total of 2,164 registry participants had available proteinuria data, of which 28% had proteinuria.
Implications of proteinuria in patients with AF
Compared with patients without proteinuria, those with proteinuria were older (75.8 years vs. 73.4 years; P < .01); had lower hemoglobin (12.5 g/dL vs. 13.1 g/dL; P < .01), estimated glomerular filtration rate (52.2 mL/min/1.73 m2 vs. 63.2 mL/min/1.73 m2; P < .01) and left ventricular ejection fraction (61.4% vs. 63.5%; P < .01); and had more comorbidities including hypertension, diabetes, previous stroke and preexisting HF.
Over a median follow-up of 5 years, the rate of HF events was higher in patients with AF plus proteinuria compared with those with AF but without proteinuria (4.1% vs. 2.1% per person-year; P < .01).
Researchers reported that proteinuria was an independent risk factor for HF events compared with no proteinuria (adjusted HR = 1.4; 95% CI, 1.13-1.74).
“To the best of our knowledge, this is the first study assessing the association between proteinuria with HF events in patients with AF,” the researchers wrote.
Subgroup analysis of younger patients with AF
In addition, the association between proteinuria and HF events among patients with AF was consistent across subgroup analyses, except that the effect was stronger in patients younger than 75 years (HR = 3.03; 95% CI, 2.12-4.34) compared with patients aged 75 years or older (HR = 1.59; 95% CI, 1.23-2.05; P for interaction < .01).
“Current guidelines recommend proteinuria screening among high-risk populations such as elderly patients and those with hypertension or diabetes mellitus,” the researchers wrote. “However, our subgroup analysis indicates that the association of proteinuria and the incidence of HF events was stronger in younger patients with AF. From this result, the dipstick test of proteinuria may be particularly useful for young patients with AF that are apparently low risk, as the dipstick test is suitable for frequent testing and is simple to use and cheap.”
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Ikeda S, et al. Eur Heart J Qual Care Clin Outcomes. 2023;doi:10.1093/ehjqcco/qcad001/6972367.