Proteinuria as a risk factor for cardiovascular disease and mortality in older people: a prospective study.
BACKGROUND
The prognostic significance of proteinuria in older people is not well defined. We examined the associations between proteinuria and incident coronary heart disease, cardiovascular mortality, and all-cause mortality in older people.


METHODS
Casual dipstick proteinuria was determined in 1,045 men (mean [+/- SD] age 68 +/- 7 years) and 1,541 women (mean age 69 +/- 7 years) attending the 15th biennial examination of the Framingham Heart Study. Participants were divided by grade of proteinuria: none (85.3%), trace (10.2%), and greater-than-trace (4.5%). Cox proportional hazards analyses were used to determine the relations of baseline proteinuria to the specified outcomes, adjusting for other risk factors, including serum creatinine level.


RESULTS
During 17 years of follow-up, there were 455 coronary heart disease events, 412 cardiovascular disease deaths, and 1,214 deaths. In men, baseline proteinuria was associated with all-cause mortality (hazards ratio [HR] = 1.3, 95% confidence interval [CI] 1.0 to 1.7 for trace proteinuria; HR = 1.3, 95% CI 1.0 to 1.8 for greater-than-trace proteinuria; P for trend = 0.02). In women, trace proteinuria was associated with cardiovascular disease death (HR = 1. 6, 95% CI 1.1 to 2.4), and all-cause mortality (HR = 1.4, 95% CI 1.1 to 1.7).


CONCLUSIONS
Proteinuria is a significant, although relatively weak, risk factor for all-cause mortality in men and women, and for cardiovascular disease mortality in women.
Culleton
B F
BF
National Heart, Lung, and Blood Institute's Framingham Heart Study Framingham, Massachusetts 01702, USA.
Larson
M G
MG
Parfrey
P S
PS
Kannel
W B
WB
Levy
D
D
D000367:Age Factors; D000368:Aged; D015415:Biomarkers / Q000097:blood / Q000652:urine; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000378:metabolism / Q000401:mortality*; D002423:Cause of Death; D003404:Creatinine / Q000097:blood; D018450:Disease Progression; D005260:Female; D006801:Humans; D008297:Male; D008404:Massachusetts / Q000453:epidemiology; D016016:Proportional Hazards Models; D011446:Prospective Studies; D011507:Proteinuria / Q000097:blood / Q000150:complications* / Q000652:urine; D012307:Risk Factors; D017678:Sex Distribution; D015996:Survival Rate
D015415:Biomarkers; D003404:Creatinine