title: Low-grade albuminuria and the incidence of heart failure in a community-based cohort of elderly men.
abstract: OBJECTIVE
  To investigate associations of urinary albumin excretion rate (UAER) and heart failure (HF) incidence in a community-based sample.
  
  
  RESULTS
  In a prospective study of 70-year-old men free from HF at baseline (n = 1106), UAER (from timed overnight samples) was analysed with established risk factors for HF [acute MI before baseline, acute MI during follow-up (modelled as a time-dependent covariate), hypertension, diabetes, left ventricular hypertrophy, smoking, body mass index, and glomerular filtration rate] and more recently described risk factors [high-sensitive C-reactive protein and insulin sensitivity (clamp glucose disposal rate)] as predictors of HF incidence. Ninety-eight participants developed HF during a median follow-up of 9.0 years. In Cox proportional hazards models adjusted for established and novel risk factors for HF, a 1 SD increase in log UAER increased the risk of HF in individuals without anti-hypertensive treatment (hazard ratio 1.49; 95% CI 1.13-1.98; P = 0.005). Furthermore, UAER remained an independent predictor of HF, also in participants without diabetes at baseline or myocardial infarction at baseline or during follow-up. There were no significant associations between UAER and HF incidence in individuals with anti-hypertensive treatment.
  
  
  CONCLUSIONS
  Our observations support the notion that low-grade albuminuria is a marker for subclinical cardiovascular damage that predisposes to future HF in the community.
authors.affiliation: Section of Geriatrics, Department of Public Health and Caring Sciences, Uppsala University, Uppsala Science Park, Uppsala, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Ingelsson
authors.forename: Johan
authors.initials: J
authors.lastname: Sundström
authors.forename: Lars
authors.initials: L
authors.lastname: Lind
authors.forename: Ulf
authors.initials: U
authors.lastname: Risérus
authors.forename: Anders
authors.initials: A
authors.lastname: Larsson
authors.forename: Samar
authors.initials: S
authors.lastname: Basu
authors.forename: Johan
authors.initials: J
authors.lastname: Arnlöv
mesh_terms: D000368:Aged; D000419:Albuminuria / Q000150:complications*; D015415:Biomarkers / Q000652:urine; D015331:Cohort Studies; D006333:Heart Failure / Q000209:etiology* / Q000401:mortality; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D012044:Regression Analysis; D051437:Renal Insufficiency; D012307:Risk Factors; D016019:Survival Analysis; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers