Author + information
- Received October 30, 2018
- Revision received January 10, 2019
- Accepted January 29, 2019
- Published online April 29, 2019.
- Luke N. Bailey, BSa,
- Emily B. Levitan, ScDb,
- Suzanne E. Judd, PhDc,
- Madeline R. Sterling, MD, MPH, MScd,
- Parag Goyal, MD, MScd,e,
- Mary Cushman, MDf,
- Monika M. Safford, MDd and
- Orlando M. Gutiérrez, MD, MMSca,b,∗ ()
- aDepartment of Medicine, University of Alabama at Birmingham, Birmingham, Alabama
- bDepartment of Epidemiology, University of Alabama at Birmingham, Birmingham, Alabama
- cDepartment of Biostatistics, University of Alabama at Birmingham, Birmingham, Alabama
- dDivision of General Internal Medicine, Department of Medicine, Weill Cornell Medical College, New York, New York
- eDivision of Cardiology, Department of Medicine, Weill Cornell Medical College, New York, New York
- fDepartment of Medicine and Pathology, Larner College of Medicine at the University of Vermont, Burlington, Vermont
- ↵∗Address for correspondence:
Dr. Orlando M. Gutiérrez, University of Alabama at Birmingham, ZRB 638, 1720 2nd Avenue South, Birmingham, Alabama 35294.
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.
Supported by cooperative agreements between the National Institute of Neurological Disorders and Stroke (NINDS), grants U01 NS041588 and R01NS080850, and National Heart, Lung and Blood Institute (NHLBI), grant R01 HL080477. The content is the sole responsibility of the authors and does not necessarily represent the official views of NINDS, NHLBI, or National Institutes of Health. Representatives of the funding agency were involved in the review of the manuscript but not directly involved in the collection, management, analysis, or interpretation of the data. Additional funding was provided by Amgen Corp. Amgen did not have any role in the design and conduct of the study or collection, management, data analysis, or interpretation of the data, or preparation of the manuscript. Dr. Gutiérrez is supported by National Institute of Digestive, Diabetes and Kidney Diseases grant K24DK116180; has received grant funding and consulting fees from Amgen; and has received funding from GlaxoSmithKline and Keryx. Dr. Levitan has received research funding from and is an advisory board member of Amgen; and is a consultant for Novartis. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received October 30, 2018.
- Revision received January 10, 2019.
- Accepted January 29, 2019.
- 2019 American College of Cardiology Foundation
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